DeCarli C, Miller B L, Swan G E, Reed T, Wolf P A, Carmelli D
Department of Neurology, University of California at Davis, 4860 Y St, Suite 3700, Sacramento, CA 95817, USA.
Arch Neurol. 2001 Apr;58(4):643-7. doi: 10.1001/archneur.58.4.643.
To evaluate the relative risk (RR) of mild cognitive impairment (MCI) associated with cerebrovascular risk factors and cerebrovascular-related brain changes.
Mild cognitive impairment was determined for the subjects of the prospective National Heart, Lung, and Blood Institute Twin Study. Quantitative measures of brain, white matter hyperintensity, cerebral infarction, apolipoprotein E genotype, and psychometric testing were obtained.
Subjects with MCI were older (73.5 +/- 3.0 vs 72.1 +/- 2.8 years), consumed less alcohol (3.7 +/- 5.8 vs 7.0 +/- 10.7 drinks per week), had greater white matter hyperintensity volumes (0.56% +/- 0.82% vs 0.25% +/- 0.34% of cranial volume), and had an increased prevalence of apolipoprotein E4 genotype (31.4% vs 19.2%) than normal subjects. White matter hyperintensity and the presence of the apolipoprotein E4 genotype were associated with a significantly increased risk for MCI. When all subjects were included in the analysis, alcohol consumption was associated with a reduced risk for MCI (RR = 0.93, P<.05). When subjects with a history of symptomatic cerebrovascular disease were excluded from the analysis, elevated midlife diastolic blood pressure was associated with an increased risk for MCI (RR = 1.70, P<.05).
Elevated midlife blood pressures, and the resulting increased white matter hyperintensities, increase the risk for MCI in a group of community-dwelling older men to at least the same degree as apolipoprotein E4 genotype. Given the common occurrence of elevations in midlife blood pressure, early and effective treatment may be warranted to prevent late-life brain abnormalities and MCI. Moreover, since many individuals with MCI progress to clinical dementia, longitudinal evaluations of this cohort will be important.
评估与脑血管危险因素及脑血管相关脑改变相关的轻度认知障碍（MCI）的相对风险（RR）。
在前瞻性的美国国立心肺血液研究所双生子研究中确定研究对象的轻度认知障碍情况。获取脑部、白质高信号、脑梗死、载脂蛋白E基因型的定量测量结果以及心理测量测试结果。
与正常受试者相比，MCI患者年龄更大（73.5±3.0岁对72.1±2.8岁），饮酒量更少（每周3.7±5.8杯对7.0±10.7杯），白质高信号体积更大（占颅腔体积的0.56%±0.82%对0.25%±0.34%），且载脂蛋白E4基因型的患病率更高（31.4%对19.2%）。白质高信号和载脂蛋白E4基因型的存在与MCI风险显著增加相关。当将所有受试者纳入分析时，饮酒与MCI风险降低相关（RR = 0.93，P<0.05）。当将有症状性脑血管疾病病史的受试者排除在分析之外时，中年舒张压升高与MCI风险增加相关（RR = 1.70，P<0.05）。
中年血压升高以及由此导致的白质高信号增加，在一组社区居住的老年男性中增加MCI风险的程度至少与载脂蛋白E4基因型相同。鉴于中年血压升高很常见，可能有必要进行早期有效治疗以预防晚年脑异常和MCI。此外，由于许多MCI患者会进展为临床痴呆，对该队列进行纵向评估将很重要。
