Meyer J S, Rauch G M, Crawford K, Rauch R A, Konno S, Akiyama H, Terayama Y, Haque A
Cerebral Blood Flow Laboratory, Veterans Administration Medical Center, Houston, TX 77030, USA.
Int J Geriatr Psychiatry. 1999 Dec;14(12):1050-61. doi: 10.1002/(sici)1099-1166(199912)14:12<1050::aid-gps56>3.0.co;2-z.
Factors accelerating cerebral degenerative changes represent potentially modifiable risks for cognitive decline. Putative risk factors accelerating subtle cognitive decline and dementia were correlated with repeated measures of cerebral atrophy, CT densitometry, perfusions and cognitive testing among neurologically and cognitively normative ageing volunteers.
Two hundred and twenty-four normative subjects at increased risk for cognitive decline were admitted to the study. Mean entry age was 59. 5+/-15.8 years. Mean follow-up is 4.3+/-3.1 years. At follow-up, 22 developed subtle cognitive decline (deltaCCSE>/=-3), 19 became demented, eight with vascular type (VAD) and 11 with Alzheimer's type (DAT) and 183 remain cognitively unchanged. Standardized questionnaires, medical, neuropsychological, neurological and blood work examinations were obtained. Cerebral atrophy, tissue densities and perfusions were measured by xenon-enhanced CT.
After age 60, cerebral atrophy, ventricular enlargement, polio- and leuko-araiosis geometrically increased as perfusions declined. Risk factors accelerating perfusional decline, cerebral atrophy, polio-araiosis and leuko-araiosis (thinning of grey-white matter densities) were: transient ischaemic attacks (TIAs), hypertension, smoking, hyperlipidemia, male gender. At age 71.5+/-11.9, subtle cognitive decline began, accelerated by TIAs, hypertension and heart disease. Leuko-araiosis began before cognitive decline. TIAs, hypertension and hyperlipidemia correlated with VAD. Excessive cortical perfusional decreases and cerebral atrophy correlated with cognitive decline. Family history of neurodegenerative disease correlated with DAT.
TIAs, hypertension, hyperlipidemia, smoking and male gender accelerate cerebral degenerative changes, cognitive decline and dementia.
加速脑退行性变的因素是认知功能下降潜在的可改变风险因素。在神经和认知功能正常的老年志愿者中，加速轻微认知功能下降和痴呆的假定风险因素与脑萎缩、CT密度测定、灌注及认知测试的重复测量结果相关。
224名认知功能下降风险增加的正常受试者纳入本研究。平均入组年龄为59.5±15.8岁。平均随访时间为4.3±3.1年。随访时，22人出现轻微认知功能下降（简易精神状态检查表变化值≥-3），19人发生痴呆，其中8例为血管性痴呆（VAD），11例为阿尔茨海默病型痴呆（DAT），183人认知功能未改变。获取标准化问卷、医学、神经心理学、神经学及血液检查结果。采用氙增强CT测量脑萎缩、组织密度及灌注。
60岁以后，随着灌注下降，脑萎缩、脑室扩大、脑软化及脑白质疏松呈几何级数增加。加速灌注下降、脑萎缩、脑软化及脑白质疏松（灰白质密度变薄）的风险因素为：短暂性脑缺血发作（TIA）、高血压、吸烟、高脂血症、男性。在71.5±11.9岁时，轻微认知功能下降开始出现，由TIA、高血压及心脏病加速。脑白质疏松在认知功能下降之前就已出现。TIA、高血压及高脂血症与VAD相关。皮质灌注过度下降及脑萎缩与认知功能下降相关。神经退行性疾病家族史与DAT相关。
TIA、高血压、高脂血症、吸烟及男性会加速脑退行性变、认知功能下降及痴呆。
