Location of lacunar infarcts correlates with cognition in a sample of non-disabled subjects with age-related white-matter changes: the LADIS study
Location of lacunar infarcts correlates with cognition in a sample of non-disabled subjects with age-related white-matter changes: the LADIS study
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DOI：
10.1136/jnnp.2008.160440
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发表时间：
2009-05-01
影响因子：
11
通讯作者：
Chabriat, H.
中科院分区：
文献类型：
--
作者：
Benisty, S.;Gouw, A. A.;Chabriat, H.
目的：在脑小血管病中，白质高信号（WMH）和腔隙都与认知功能有关。尽管如此，它们各自在老年人中的作用仍不清楚。本研究的目的是评估的地形分布的腔隙，并确定它是否有影响的认知功能在一个样本的非残疾患者与年龄相关的白质changes.Methods：数据来自基线评估的LADIS（Leucoaraioisis和残疾研究）队列的非残疾受试者超过65岁。神经心理学评估基于简易精神状态检查（MMSE），一种用于整体认知功能的改良阿尔茨海默病评估量表，以及记忆、执行功能、速度和运动控制的复合Z评分。根据Fazekas量表对WMH进行评级;评估以下区域的腔隙数量：脑叶白色物质、壳核/苍白球、丘脑、尾状核、内/外囊、幕下区域。协方差分析进行调整后，可能的confounders.Results：在633例受试者中，47%至少有一个腔隙（31%至少有一个在基底节）。丘脑腔隙的存在与MMSE评分较低（β = -0.61; p = 0.043）、速度和运动控制（β = -0.25; p = 0.006）、执行功能（β = -0.19; p = 0.022）的复合评分较差相关，与WMH的认知影响无关。壳核/苍白球中存在的腔隙与记忆化合物Z评分之间也存在显著的负相关性（β = -0.13; p = 0.038）。相比之下，没有显着的负相关性之间的认知参数和存在的腔隙内囊，叶白色物质和尾状核。结论：在非残疾老年人与leucoaraisosis，皮层下灰质内的腔隙的位置是一个决定性的认知障碍，独立的WMH的程度。
Objectives: In cerebral small vessel disease, white-matter hyperintensities (WMH) and lacunes are both related to cognition. Still, their respective contribution in older people remains unclear. The purpose of this study is to assess the topographic distribution of lacunes and determine whether it has an impact on cognitive functions in a sample of non-disabled patients with age-related white-matter changes.Methods: Data were drawn from the baseline evaluation of the LADIS (Leucoaraioisis and Disability study) cohort of non-disabled subjects beyond 65 years of age. The neuropsychological evaluation was based on the Mini Mental Status Examination (MMSE), a modified Alzheimer Diseases Assessment Scale for global cognitive functions, and compound Z scores for memory, executive functions, speed and motor control. WMH were rated according to the Fazekas scale; the number of lacunes was assessed in the following areas: lobar white matter, putamen/pallidum, thalamus, caudate nucleus, internal/external capsule, infratentorial areas. An analysis of covariance was performed after adjustment for possible confounders.Results: Among 633 subjects, 47% had at least one lacune (31% at least one within basal ganglia). The presence of lacunes in the thalamus was associated with lower scores of MMSE (beta = -0.61; p = 0.043), and worse compound scores for speed and motor control (beta = -0.25; p = 0.006), executive functions (beta = -0.19; p = 0.022) independently of the cognitive impact of WMH. There was also a significant negative association between the presence of lacunes in putamen/pallidum and the memory compound Z score (beta = -0.13; p = 0.038). By contrast, no significant negative association was found between cognitive parameters and the presence of lacunes in internal capsule, lobar white matter and caudate nucleus.Conclusion: In non-disabled elderly subjects with leucoaraisosis, the location of lacunes within subcortical grey matter is a determinant of cognitive impairment, independently of the extent of WMH.