Extent and distribution of white matter hyperintensities in normal aging, MCI, and AD
Extent and distribution of white matter hyperintensities in normal aging, MCI, and AD
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DOI：
10.1212/01.wnl.0000249119.95747.1f
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发表时间：
2006-12-26
期刊：
影响因子：
9.9
通讯作者：
DeCarli, C. S.
中科院分区：
文献类型：
--
作者：
Yoshita, M.;Fletcher, E.;DeCarli, C. S.
目的：分析认知正常老年人（CN）和轻度认知障碍（MCI）、阿尔茨海默病（AD）患者脑区白质高信号（WMH）的程度和空间分布。方法：轻度AD 26例，轻度轻度AD 28例，CN 33例。MRI分析包括量化WMH体积，非线性映射到共同的解剖图像，以及每个WMH体素的空间定位，以创建解剖学上精确的频率分布图。WMH复合图中WMH频率最高的区域被用来识别涉及脑室周围区域和胼胝体（CC）的10个解剖区域，以进行组比较。结果：WMH总体积与年龄、并发血管危险因素的程度和诊断有关。在校正年龄后，总WMH体积仍然与诊断和血管危险程度显著相关。区域WMH分析显示，各区域的WMH存在显著差异，根据诊断结果也存在显著差异。在事后分析中，CN和AD在CC的后心室周围区域和脾区有显著差异，MCI受试者在所有区域都有中间值。包括模型中血管危险因素在内的重复测量分析发现，心室周围WMH与血管危险之间存在显著的区域差异，但根据诊断的区域差异仍然显著，诊断与血管危险之间没有相互作用。结论：脑白质高信号（WMH）的差异与认知功能障碍的程度和空间位置有关。区域WMH、血管危险因素和诊断的多元回归分析表明，这些空间差异可能是血管损伤和退行性损伤的叠加作用所致。与轻度认知障碍和阿尔茨海默病相关的WMH后脑室周围和胼胝体延伸表明，战略性白质束的累及可能导致这些综合征中出现的认知缺陷。
Objective: To analyze the extent and spatial distribution of white matter hyperintensities (WMH) in brain regions from cognitively normal older individuals (CN) and patients with mild cognitive impairment (MCI) and Alzheimer disease (AD). Methods: We studied 26 mild AD, 28 MCI, and 33 CN. MRI analysis included quantification of WMH volume, nonlinear mapping onto a common anatomic image, and spatial localization of each WMH voxel to create an anatomically precise frequency distribution map. Areas of greatest frequency of WMH from the WMH composite map were used to identify 10 anatomic regions involving periventricular areas and the corpus callosum (CC) for group comparisons. Results: Total WMH volumes were associated with age, extent of concurrent vascular risk factors, and diagnosis. After correcting for age, total WMH volumes remained significantly associated with diagnosis and extent of vascular risk. Regional WMH analyses revealed significant differences in WMH across regions that also differed significantly according to diagnosis. In post-hoc analyses, significant differences were seen between CN and AD in posterior periventricular regions and the splenium of the CC. MCI subjects had intermediate values at all regions. Repeated measures analysis including vascular risk factors in the model found a significant relationship between periventricular WMH and vascular risk that differed by region, but regional differences according to diagnosis remained significant and there was no interaction between diagnosis and vascular risk. Conclusions: Differences in white matter hyperintensities (WMH) associated with increasing cognitive impairment appear related to both extent and spatial location. Multiple regression analysis of regional WMH, vascular risk factors, and diagnosis suggest that these spatial differences may result from the additive effects of vascular and degenerative injury. Posterior periventricular and corpus callosum extension of WMH associated with mild cognitive impairment and Alzheimer disease indicate involvement of strategic white matter bundles that may contribute to the cognitive deficits seen with these syndromes.