de Leeuw F E, De Groot J C, Oudkerk M, Witteman J C, Hofman A, van Gijn J, Breteler M M
Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands.
Stroke. 2000 Feb;31(2):425-9. doi: 10.1161/01.str.31.2.425.
MRI scans of the brains of elderly people frequently show white matter lesions. Clinically, these lesions are associated with cognitive impairment and dementia. A relation between atherosclerosis and white matter lesions was found in some small cross-sectional studies. However, atherosclerosis is a gradual process that starts early in life. We investigated the longitudinal association between aortic atherosclerosis assessed during midlife and late life and cerebral white matter lesions.
We randomly sampled subjects between 60 and 90 years old from 2 population-based follow-up studies in which subjects had their baseline examinations in 1975 to 1978 (midlife) and in 1990 to 1993 (late life). In 1995 to 1996, subjects underwent 1.5-T MRI scanning; white matter lesions were rated in the deep subcortical and periventricular regions separately. Aortic atherosclerosis was assessed on abdominal radiographs that were obtained from 276 subjects in midlife and 531 subjects in late life.
The presence of aortic atherosclerosis during midlife was significantly associated with the presence of periventricular white matter lesions approximately 20 years later (adjusted relative risk, 2.4; 95% CI, 1.2 to 5.0); the relative risks increased linearly with the severity of aortic atherosclerosis. No association was found between midlife aortic atherosclerosis and subcortical white matter lesions (adjusted relative risk, 1.1; 95% CI, 0.5 to 2.3) or between late-life aortic atherosclerosis and white matter lesions.
The pathogenetic process that leads to cerebral periventricular white matter lesions starts already in or before midlife. The critical period for intervention directed at prevention of white matter lesions and its cognitive consequences may be long before these lesions become clinically detectable.
老年人脑部的MRI扫描经常显示白质病变。临床上，这些病变与认知障碍和痴呆有关。在一些小型横断面研究中发现动脉粥样硬化与白质病变之间存在关联。然而，动脉粥样硬化是一个从生命早期就开始的渐进过程。我们研究了中年和晚年评估的主动脉粥样硬化与脑白质病变之间的纵向关联。
我们从两项基于人群的随访研究中随机抽取了60至90岁的受试者，这些受试者在1975年至1978年（中年）和1990年至1993年（晚年）进行了基线检查。1995年至1996年，受试者接受了1.5-T MRI扫描；分别对深部皮质下和脑室周围区域的白质病变进行评分。通过对276名中年受试者和531名老年受试者的腹部X光片评估主动脉粥样硬化情况。
中年时存在主动脉粥样硬化与大约20年后脑室周围白质病变的存在显著相关（调整后的相对风险为2.4；95%可信区间为1.2至5.0）；相对风险随主动脉粥样硬化的严重程度呈线性增加。未发现中年主动脉粥样硬化与皮质下白质病变之间存在关联（调整后的相对风险为1.1；95%可信区间为0.5至2.3），也未发现晚年主动脉粥样硬化与白质病变之间存在关联。
导致脑室周围脑白质病变的发病过程在中年或中年之前就已开始。针对预防白质病变及其认知后果的干预关键期可能远在这些病变临床可检测到之前。
