De Groot Jan Cees, De Leeuw Frank-Erik, Oudkerk Matthijs, Van Gijn Jan, Hofman Albert, Jolles Jellemer, Breteler Monique M B
Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
Ann Neurol. 2002 Sep;52(3):335-41. doi: 10.1002/ana.10294.
The prospect of declining cognitive functions is a major fear for many elderly persons. Cerebral white matter lesions, as commonly found with magnetic resonance imaging, have been associated with cognitive dysfunction in cross-sectional studies. Only a few longitudinal studies using small cohorts confirmed these findings. We examined the relation between severity of white matter lesions and cognitive decline over a nearly 10-year period in 563 elderly subjects sampled from the general nondemented Dutch population. Severity of white matter lesions was scored for periventricular and subcortical regions separately using an extensive semiquantitative scale. Cognitive function was measured by the Mini-Mental State Examination at regular time intervals during 1990 to 2000, and magnetic resonance imaging scans were made in 1995 to 1996. More severe white matter lesions were associated with more rapid cognitive decline over a mean follow-up period of 7.3 years (standard deviation, 1.5). After adjusting for age, gender, educational level, measures of depression, and brain atrophy and infarcts, subjects with severe periventricular white matter lesions experienced cognitive decline nearly three times as fast (0.28 Mini-Mental State Examination points/year [95% confidence interval, 0.20-0.36]) as the average (0.10 points/year [95% confidence interval, 0.09-0.11]). There was no independent relationship between severity of subcortical white matter lesions and rate of cognitive decline.
认知功能衰退的前景是许多老年人的一大担忧。正如磁共振成像常见的那样，脑白质病变在横断面研究中与认知功能障碍有关。仅有少数使用小样本队列的纵向研究证实了这些发现。我们在从荷兰非痴呆普通人群中抽取的563名老年受试者中，研究了近10年期间脑白质病变严重程度与认知衰退之间的关系。使用广泛的半定量量表分别对脑室周围和皮质下区域的脑白质病变严重程度进行评分。在1990年至2000年期间定期通过简易精神状态检查表测量认知功能，并在1995年至1996年进行磁共振成像扫描。在平均7.3年（标准差1.5）的随访期内，更严重的脑白质病变与更快的认知衰退相关。在对年龄、性别、教育水平、抑郁测量指标以及脑萎缩和梗死进行校正后，患有严重脑室周围脑白质病变的受试者认知衰退速度几乎是平均速度（每年0.10分[95%置信区间，0.09 - 0.11]）的三倍（每年0.28分[95%置信区间，0.20 - 0.36]）。皮质下脑白质病变严重程度与认知衰退速度之间没有独立关系。
