Measuring cerebral atrophy and white matter hyperintensity burden to predict the rate of cognitive decline in Alzheimer disease.
Measuring cerebral atrophy and white matter hyperintensity burden to predict the rate of cognitive decline in Alzheimer disease.
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DOI：
10.1001/archneur.65.9.1202
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发表时间：
2008-09
影响因子：
--
通讯作者：
Stern, Yaakov
中科院分区：
文献类型：
--
作者：
Brickman, Adam M.;Honig, Lawrence S.;Scarmeas, Nikolaos;Tatarina, Oksana;Sanders, Linda;Albert, Marilyn S.;Brandt, Jason;Blacker, Deborah;Stern, Yaakov
虽然没有特异性，但脑萎缩和白色高信号（WMH）是与阿尔茨海默病（AD）相关的神经变性的特征。本研究的目的是确定脑萎缩和WMH的基线测量值是否可预测AD患者未来认知能力下降的速度。数据来自预测者研究，这是一项纵向研究，招募轻度AD患者，每六个月用哥伦比亚改良的简易精神状态检查（mMMS; 0-57）重新评估他们。分析MRI图像以确定WMH的严重程度（Scheltens量表）和萎缩程度（双尾状核比率）。使用广义估计方程（GEE）确定基线MRI测量值的严重程度及其相互作用是否可预测后续访视时mMMS下降率。美国三所大学的AD中心（预测研究）。来自预测因子研究的84名AD患者在基线时接受了结构MRI，并被选择用于分析。他们平均有6次后续评价。认知（哥伦比亚改良简易精神状态检查）。广义估计方程模型表明，基线萎缩程度（β = −0.316，p = 0.036）、WMH严重程度（β = −0.173，p = 0.028）及其相互作用（β = − 6.061，p = 0.018）可预测mMMS评分下降率。脑萎缩的程度和WMH的严重程度都与AD认知功能下降的速度有关。萎缩和WMH可能相互作用，对未来的衰退产生协同效应，因此两者都高度相关的AD患者具有特别陡峭的认知过程。这些发现进一步支持了脑血管病变导致阿尔茨海默病临床综合征的假设。
Although non-specific, cerebral atrophy and white matter hyperintensities (WMH) are features of the neurodegeneration associated with Alzheimer’s disease (AD). The purpose of the current study was to determine if baseline measurements of cerebral atrophy and WMH predict the rate of future cognitive decline in AD. Data were drawn from the Predictors Study, a longitudinal study that enrolls mild AD patients and re-asseses them every six months with the Columbia modified Mini Mental State Examination (mMMS; 0–57). MR images were analyzed to determine the severity of WMH (Scheltens Scale) and the degree of atrophy (bicaudate ratio). Generalized estimating equations (GEE) were used to determine whether severity of baseline MRI measurements and their interaction predicted the rate of mMMS decline at subsequent visits. Three university-based AD centers in the United States (Predictors Study). Eighty-four AD patients from the Predictors Study received structural MRI at baseline and were selected for analysis. They had an average of 6 follow-up evaluations. Cognitive (Columbia modified Mini-Mental State Examination). Generalized estimating equation models demonstrated that degree of baseline atrophy (β = −0.316, p = 0.036), severity of WMH (β = −0.173, p = 0.028), and their interaction (β = − 6.061, p = 0.018) predicted rate of decline in mMMS scores. Both degree of cerebral atrophy and severity of WMH are associated with the rapidity of cognitive decline in AD. Atrophy and WMH may interact to have a synergistic effect on future decline, such that AD patients with a high degree of both have a particularly precipitous cognitive course. These findings lend further support to the hypothesis that cerebrovascular pathology contributes to the clinical syndrome of Alzheimer’s disease.
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