Longstreth W T, Arnold Alice M, Beauchamp Norman J, Manolio Teri A, Lefkowitz David, Jungreis Charles, Hirsch Calvin H, O'Leary Daniel H, Furberg Curt D
Department of Neurology, University of Washington, Seattle, Wash, USA.
Stroke. 2005 Jan;36(1):56-61. doi: 10.1161/01.STR.0000149625.99732.69. Epub 2004 Nov 29.
Magnetic resonance imaging (MRI) scans in the elderly commonly show white matter findings that may raise concerns. We sought to document incidence, manifestations, and predictors of worsening white matter grade on serial imaging.
The Cardiovascular Health Study is a population-based, longitudinal study of 5888 people aged 65 years and older, of whom 1919 have had extensive initial and follow-up evaluations, including 2 MRI scans separated by 5 years. Scans were read without clinical information in standard side-by-side fashion to determine worsening white matter grade.
Worsening was evident in 538 participants (28%), mostly (85%) by 1 grade. Although similar at initial scan, participants with worsening white matter grade, compared with those without, experienced greater decline on modified Mini-Mental State examination and Digit-Symbol Substitution test (both P< or =0.001) after controlling for potential confounding factors, including occurrence of transient ischemic attack or stroke between scans. Independent predictors of worsening white matter grade included cigarette smoking before initial scan and infarct on initial scan. Otherwise, predictors differed according to white matter grade on initial scan. For low initial grade, increased age, increased diastolic blood pressure, increased high-density lipoprotein cholesterol, and decreased low-density lipoprotein cholesterol were associated with increased risk of worsening. For high initial grade, any cardiovascular disease and low ankle-arm index were associated with decreased risk of worsening, whereas use of diuretics and statins were associated with increased risk.
Worsening white matter grade on serial MRI scans in elderly is common, is associated with cognitive decline, and has complex relations with cardiovascular risk factors.
老年人的磁共振成像（MRI）扫描通常会显示出可能引发担忧的白质病变。我们试图记录连续成像中白质分级恶化的发生率、表现及预测因素。
心血管健康研究是一项基于人群的纵向研究，涉及5888名65岁及以上的人群，其中1919人接受了广泛的初始评估和随访评估，包括间隔5年的两次MRI扫描。在不了解临床信息的情况下，以标准的并排方式解读扫描结果，以确定白质分级恶化情况。
538名参与者（28%）出现了白质分级恶化，大多数（85%）恶化1级。尽管在初始扫描时情况相似，但在控制了包括两次扫描之间短暂性脑缺血发作或中风的发生等潜在混杂因素后，白质分级恶化的参与者与未恶化的参与者相比，在改良简易精神状态检查和数字符号替换测试中下降更为明显（P均≤0.001）。白质分级恶化的独立预测因素包括初始扫描前吸烟和初始扫描时存在梗死。否则，预测因素因初始扫描时的白质分级而异。对于初始分级较低的情况，年龄增加、舒张压升高、高密度脂蛋白胆固醇升高和低密度脂蛋白胆固醇降低与恶化风险增加相关。对于初始分级较高的情况，任何心血管疾病和低踝臂指数与恶化风险降低相关，而使用利尿剂和他汀类药物与恶化风险增加相关。
老年人连续MRI扫描中白质分级恶化很常见，与认知功能下降有关，并且与心血管危险因素存在复杂关系。
