Lazarus R, Prettyman R, Cherryman G
Leicestershire Partnership NHS Trust, Brandon Mental Health Unit, Leicester General Hospital, Leicester, UK.
Int J Geriatr Psychiatry. 2005 Mar;20(3):274-9. doi: 10.1002/gps.1283.
The association between white matter lesions on magnetic resonance imaging (MRI) and the presence of vascular risk factors has been investigated in different populations, and results have varied widely. However, this relationship has not been adequately addressed in memory clinic attenders who have relatively early cognitive impairment.
This study was undertaken to determine the relationship between the severity of white matter lesions and vascular risk factors in elderly subjects referred to a Memory Clinic, irrespective of their diagnoses. Patients attending the Memory Clinic had relatively early, mild cognitive impairment and differed, in this respect, from typical unselected community-based samples and from patients with established dementia. The study also investigated whether periventricular and deep white matter lesions differed in their relationship with vascular risk factors.
All patients assessed in the Memory Clinic at Leicester General Hospital between April 1998 and October 2000 who had undergone an MRI scan were included in the study. They received a comprehensive clinical and cognitive assessment, a standard dementia laboratory screen and evaluation of vascular risk factors. MRI scans were reviewed by two independent raters and semi-quantitative ratings of the severity of white matter lesions were made using standardised protocols. The relationship between cerebral white matter lesions and vascular risk factor variables was examined by multiple linear regression.
One hundred and seventy-seven subjects were included in the study. The mean age was 69.8 and the mean MMSE score was 23.2. Of the risk factors investigated, only age and prior cerebrovascular disease were significantly associated with severe periventricular white matter lesions; age, hypertension and diabetes were significantly associated with severe deep white matter lesions.
Periventricular and deep white matter lesions are differentially influenced by vascular risk factors.
磁共振成像（MRI）显示的白质病变与血管危险因素之间的关联已在不同人群中进行了研究，结果差异很大。然而，在患有相对早期认知障碍的记忆门诊就诊者中，这种关系尚未得到充分探讨。
本研究旨在确定转诊至记忆门诊的老年受试者中白质病变严重程度与血管危险因素之间的关系，无论其诊断如何。在记忆门诊就诊的患者有相对早期、轻度的认知障碍，在这方面与典型的未经过选择的社区样本以及已确诊痴呆的患者不同。该研究还调查了脑室周围白质病变和深部白质病变与血管危险因素的关系是否存在差异。
1998年4月至2000年10月期间在莱斯特总医院记忆门诊接受评估且已进行MRI扫描的所有患者均纳入本研究。他们接受了全面的临床和认知评估、标准的痴呆实验室筛查以及血管危险因素评估。两名独立评估者对MRI扫描结果进行了复查，并使用标准化方案对白质病变严重程度进行了半定量评分。通过多元线性回归分析脑白质病变与血管危险因素变量之间的关系。
177名受试者纳入研究。平均年龄为69.8岁，平均简易精神状态检查表（MMSE）评分为23.2分。在所研究的危险因素中，只有年龄和既往脑血管疾病与严重的脑室周围白质病变显著相关；年龄、高血压和糖尿病与严重的深部白质病变显著相关。
脑室周围白质病变和深部白质病变受血管危险因素的影响不同。
