Meyer J S, Kawamura J, Terayama Y
Cerebrovascular Research Laboratories, Department of Veterans Affairs Medical Center, Houston, Texas 77030.
J Neurol Sci. 1992 Jul;110(1-2):1-7. doi: 10.1016/0022-510x(92)90002-3.
The advent of neuroimaging has brought medical attention to the frequency of unsuspected white matter lesions in the brains of elderly people. In 1987 Hachinski suggested the term "leuko-araiosis" to identify such white matter abnormalities detected by computed tomography and magnetic resonance imaging to emphasize that their etiology and clinical relevance require clarification. Since then, leuko-araiosis has been recognized among approximately ten percent of apparently normal, elderly people over age sixty-five. The severity and frequency of leuko-araiosis increases with advancing age, risk factors for stroke, history of strokes particularly of the lacunar type and dementia of both the vascular and Alzheimer type. Current concepts concerning the pathogenesis and neurological concomitants of leuko-araiosis are reviewed. The etiology of leuko-araiosis may be heterogeneous but is most likely ischemic in nature. However, as white matter lesions progress among the elderly they are likely to become associated with cognitive impairments and motor dyspraxias presumably resulting from cortico-subcortical disconnections, particularly involving the frontal cortex and basal ganglia and may themselves be considered a radiological "risk factor" or precursor for dementia.
神经影像学的出现使医学界开始关注老年人脑中未被察觉的白质病变的发生率。1987年，哈钦斯基提出了“脑白质疏松症”这一术语，以识别通过计算机断层扫描和磁共振成像检测到的此类白质异常，强调其病因和临床相关性需要阐明。从那时起，在65岁以上看似正常的老年人中，约有10%被发现患有脑白质疏松症。脑白质疏松症的严重程度和发生率随着年龄的增长、中风风险因素、中风病史（尤其是腔隙性中风）以及血管性和阿尔茨海默型痴呆而增加。本文综述了目前关于脑白质疏松症发病机制和神经伴随症状的概念。脑白质疏松症的病因可能是异质性的，但最可能本质上是缺血性的。然而，随着老年人白质病变的进展，它们可能会与认知障碍和运动性运用障碍相关联，推测是由于皮质-皮质下联系中断，特别是涉及额叶皮质和基底神经节，并且它们本身可能被视为痴呆的一种影像学“风险因素”或先兆。
