Multiple or mixed cerebral microbleeds and dementia in patients with vascular risk factors
Multiple or mixed cerebral microbleeds and dementia in patients with vascular risk factors
复制标题
DOI：
10.1212/wnl.0000000000000692
复制
发表时间：
2014-08-12
期刊：
影响因子：
9.9
通讯作者：
Kitagawa, Kazuo
中科院分区：
文献类型：
--
作者：
Miwa, Kaori;Tanaka, Makiko;Kitagawa, Kazuo
目的：探讨脑微出血(CMBS)是否与有血管危险因素的患者的痴呆症独立相关。方法：使用2001年一项观察性研究中日本一组有血管危险因素的参与者的数据，我们评估基线时的CMBS与痴呆症的相关性。基线脑MRI用于确定小血管疾病(CMBS、腔隙梗死和脑白质高信号)和脑萎缩。结果：在524名受试者(平均年龄68+/-8.3岁，男性57.6%，受教育程度12.8+/-2.6年，21.6%)中，44名痴呆症患者(阿尔茨海默病20例，血管性痴呆18例，混合型3例，其他3例)在平均7.5年的随访期内被诊断为痴呆。在多变量分析中，总体CMBS的存在与发生全因痴呆的风险增加无关(p=0.15)。然而，多发CMBS(>；=2)或混合型(叶和深部)CMBS与全因痴呆的风险增加相关，而严格意义上的叶CMBS与任何痴呆无关。结论：多发CMBS或混合型CMBS独立显示出更高的全因痴呆风险。我们的结果强化了CMBS对痴呆症发病率产生有害影响的假设，表明这种联系可能是通过血管负担来调节的。
Objective: To investigate whether cerebral microbleeds (CMBs) are independently associated with incident dementia in patients with vascular risk factors.Methods: Using data from a Japanese cohort of participants with vascular risk factors in an observational study from 2001, we evaluated the association between CMBs at baseline and incident dementia. Baseline brain MRI was used to determine small-vessel disease (CMBs, lacunar infarcts, and white matter hyperintensities) and brain atrophy. Cox proportional hazards analyses were performed for predictors of dementia adjusting for age, sex, APOE epsilon 4 allele, educational level, baseline Mini-Mental State Examination score, cerebrovascular events, vascular risk factors, and MRI findings.Results: Of the 524 subjects (mean age 68 +/- 8.3 years, 57.6% male, 12.8 +/- 2.6 years of schooling, 21.6% CMBs), 44 patients with incident dementia (20 Alzheimer disease, 18 vascular dementia, 3 mixed-type, and 3 other) were diagnosed during the median 7.5-year follow-up. In multivariate analysis, the presence of overall CMBs was not associated with an increased risk of incident all-cause dementia (p = 0.15). However, multiple CMBs (>= 2) or mixed (lobar and deep) CMBs were associated with the increased risk of all-cause dementia, whereas strictly lobar CMBs showed no association with any dementia.Conclusions: Multiple CMBs or mixed CMBs independently showed higher risk of all-cause dementia. Our results reinforce the hypothesis that CMBs exert deleterious effects on dementia incidence, suggesting that this association may be mediated by vascular burden.