Baseline Predictors of Cognitive Decline in Patients with Cerebral Small Vessel Disease
Baseline Predictors of Cognitive Decline in Patients with Cerebral Small Vessel Disease
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DOI：
10.3233/jad-132606
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发表时间：
2014-01-01
影响因子：
4
通讯作者：
Sternic, Nada
中科院分区：
文献类型：
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作者：
Pavlovic, Aleksandra M.;Pekmezovic, Tatjana;Sternic, Nada
简介：脑小血管病（Cerebral Small Vessel Disease，SVD）是认知功能障碍和血管性痴呆的常见原因，我们的目的是探讨首次出现腔隙性皮质下小卒中但认知功能正常的SVD患者认知功能下降的预测因素。我们分析了基线人口统计学数据、血管危险因素、以改良兰金量表评分表示的功能状态、腔隙性梗死的总数、磁共振成像上白色高信号（WMH）的严重程度、脑梗死相关白色变化量表总分（tARWMC）和Fazekas量表脑室周围和深部皮质下评分。在随访时，188例（63.9%）SVD患者中检测到任何类型的血管性认知障碍（VCI），其中65例（22.1%）符合血管性痴呆标准，123例（41.8%）出现认知障碍而非痴呆。在初次临床表现时，VCI患者年龄较大（VCI组64.4 ± 10.3岁，非VCI组58.6 ± 10.5岁; p < 0.0001），男性更常见（VCI组57.9%，非VCI组46.2%; p = 0.052）。VCI与非VCI病例的血管危险因素频率无差异。经年龄和性别调整的多变量logistic回归分析确定了WMH的总体严重程度（tARWMC HR 1.42，95% CI 1.01-2.00; p0.043）和腔隙性梗死总数（HR 3.06，95%CI 1.71-5.50，p < 0.001）作为认知功能下降的独立预测因子。在SVD患者中，VCI的独立预测因素是基线WMH严重程度和腔隙性梗死总数。
Introduction: Cerebral small vessel disease (SVD) is a common cause of cognitive impairment and vascular dementia.Objective: We aimed to investigate predictors of cognitive decline in patients with SVD who initially presented with first-ever small subcortical stroke of lacunar type but had normal cognitive status.Methods: A total of 294 patients with SVD were evaluated 3-5 years after initial presentation. We analyzed baseline demographic data, vascular risk factors, functional status expressed as score on modified Rankin Scale, total number of lacunar infarcts, and severity of white matter hyperintensities (WMH) on magnetic resonance imaging with Age-Related White Matter Changes scale total score (tARWMC) and Fazekas scale periventricular and deep subcortical scores.Results: At follow-up, vascular cognitive impairment (VCI) on any type was detected in 188 (63.9%) of SVD patients, with 65 (22.1%) meeting criteria for vascular dementia and 123 (41.8%) presenting with cognitive impairment not dementia. Patients with VCI were older (64.4 +/- 10.3 in VCI versus 58.6 +/- 10.5 years in non-VCI; p < 0.0001) at the time of initial clinical presentation and more frequently male (57.9% VCI versus 46.2% non-VCI; p = 0.052). No difference was noted in frequency of vascular risk factors in VCI versus non-VCI cases. Multivariate logistic regression analysis adjusted by age and gender identified overall severity of WMH (tARWMC HR 1.42, 95% CI 1.01-2.00; p0.043) and total number of lacunar infarcts (HR 3.06, 95% CI 1.71-5.50, p < 0.001) as independent predictors of cognitive decline.Conclusion: In patients with SVD, independent predictors of VCI were baseline severity of WMH and total number of lacunar infarcts.