Cerebral Microbleeds and Long-Term Cognitive Outcome: Longitudinal Cohort Study of Stroke Clinic Patients
Cerebral Microbleeds and Long-Term Cognitive Outcome: Longitudinal Cohort Study of Stroke Clinic Patients
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DOI：
10.1159/000336237
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发表时间：
2012-01-01
影响因子：
2.9
通讯作者：
Werring, D. J.
中科院分区：
文献类型：
--
作者：
Gregoire, S. M.;Smith, K.;Werring, D. J.
背景：血管性认知障碍会导致老年人严重残疾，并且在缺血性中风后很常见。尽管潜在的机制和预后因素仍不清楚，但已知小血管疾病是其中的一个因素。脑微出血（CMB）是小血管疾病的磁共振成像（MRI）表现，可能导致血管性认知障碍，特别是额叶执行功能障碍。我们假设基线 CMB 可以预测长期认知结果，特别是额叶执行功能。方法：连续一组首次转诊至卒中诊所时发现患有 CMB 的患者，以及年龄、性别和临床放射学特征相匹配的无 CMB 对照组，被邀请在中位 5.7 年后进行后续认知评估。在基线和随访时进行 MRI 和详细的认知评估（包括当前智力功能、语言记忆、视觉记忆、命名技能、知觉功能、额叶执行功能；以及速度和注意力）。使用预定义的标准将患者在每个领域分类（对 MRI 和临床数据不知情）为受损或未受损。我们比较了基线和随访时每个领域认知障碍的患病率，并研究了额叶执行认知障碍的临床和放射学预测因素[包括基线 CMB 和白质变化 (WMC)]。结果：在最初的 55 名患者队列中，有 13 名患者在没有随访的情况下死亡。 26 名幸存患者（9 名有基线 CMB，17 名没有基线 CMB）同意进行后续神经心理学评估；其中 21 名患者接受了重复 MRI 扫描。无论是否存在基线 CMB，认知领域受损的中位数数量都会增加（有基线 CMB：随访时中位数 3、范围 0-5 与基线时中位数 2、范围 0-2，p = 0.016；无 CMB：随访时中位数 1.0、范围 0-5 与基线时中位数 0、范围 0-5，p = 0.035）。随访时，有基线 CMB 的患者比没有 CMB 的患者更容易出现额叶执行障碍（78% vs. 29%，p = 0.038）。基线 CMB 的存在预示着随访时额叶执行功能障碍（OR 8.40，95% CI 1.27-55.39，p = 0.027）。 50% 患有 CMB 的患者与 8% 没有基线 CMB 的患者出现了新的 CMB (p = 0.047)。 WMC 的严重程度增加；仅在没有基线 CMB 的患者中，差异具有统计学意义（p = 0.027）。没有出现新的皮质梗塞。结论：在中风临床患者中，CMB 始终与额叶执行障碍相关。基线 CMB 与 5.7 年后随访时的额叶执行损伤相关。 CMB 的存在与中风临床患者的长期认知结果具有预后相关性，并且可能有助于针对认知能力下降风险最高的个体制定最佳的预防策略。版权所有 (C) 2012 S. Karger AG，巴塞尔
Background: Vascular cognitive impairment causes significant disability in the elderly and is common following ischaemic stroke. Although the underlying mechanisms and prognostic factors remain unclear, small vessel diseases are known to contribute. Cerebral microbleeds (CMBs) are a magnetic resonance imaging (MRI) manifestation of small vessel diseases and may contribute to vascular cognitive impairment, particularly frontal-executive functions. We hypothesized that baseline CMBs would predict long-term cognitive outcome, specifically frontal-executive function. Methods: A cohort of consecutive patients found to have CMBs when first referred to a stroke clinic, together with a CMB-free control group matched for age, gender and clinicoradiological characteristics, were invited for follow-up cognitive assessment a median of 5.7 years later. MRI and detailed cognitive assessment (including current intellectual function, verbal memory, visual memory, naming skills, perceptual functions, frontal-executive functions; and speed and attention) were performed at baseline and follow-up. Patients were classified (blinded to MRI and clinical data) as impaired or unimpaired in each domain using predefined criteria. We compared the prevalence of cognitive impairments in each domain at baseline and follow-up and investigated clinical and radiological predictors [ including baseline CMBs and white matter changes (WMCs)] of frontal-executive cognitive impairment. Results: Of the original cohort of 55 patients, 13 died without follow-up. Twenty-six of the surviving patients (9 with, 17 without baseline CMBs) agreed to follow-up neuropsychological assessment; 21 of these patients had a repeat MRI scan. The median number of cognitive domains impaired increased, regardless of the presence of baseline CMBs (with baseline CMBs: median 3, range 0-5 at follow-up vs. median 2, range 0-2 at baseline, p = 0.016; without CMBs: median 1.0, range 0-5 at follow-up vs. median 0, range 0-5 at baseline, p = 0.035). Frontal-executive impairment at follow-up was more prevalent in patients with baseline CMBs than in those without (78 vs. 29%, p = 0.038). The presence of baseline CMBs predicted frontal-executive impairment at follow-up (OR 8.40, 95% CI 1.27-55.39, p = 0.027). Fifty percent of patients with CMBs versus 8% of patients without baseline CMBs developed new CMBs (p = 0.047). The severity of WMCs increased; the difference was statistically significant only in patients without baseline CMBs (p = 0.027). There were no new cortical infarcts. Conclusion: In stroke clinic patients, CMBs are consistently associated with frontal-executive impairment; baseline CMBs are associated with frontal- executive impairment at follow-up after 5.7 years. The presence of CMBs has prognostic relevance for long-term cognitive outcome in stroke clinic patients, and may help to optimally target preventive strategies in individuals at highest risk of cognitive decline. Copyright (C) 2012 S. Karger AG, Basel