Bastos Leite António J, van der Flier Wiesje M, van Straaten Elisabeth C W, Scheltens Philip, Barkhof Frederik
Department of Radiology and Image Analysis Center, VU University Medical Center, Amsterdam, The Netherlands.
Stroke. 2006 Jan;37(1):105-10. doi: 10.1161/01.STR.0000196984.90718.8a. Epub 2005 Dec 8.
Infratentorial abnormalities may cause cognitive deficits, but current research criteria for vascular dementia (VaD) do not consider them. Our purposes were to determine the prevalence of infratentorial abnormalities in VaD, their relation with supratentorial abnormalities, and whether they are relevant to cognition.
We examined 182 patients (120 men, mean age=73 years, SD=8) with probable VaD at inclusion into a multicenter clinical trial. MRI scans were evaluated for infratentorial vascular abnormalities, midbrain atrophy, cerebellar atrophy, basilar artery diameter and tortuosity, and supratentorial abnormalities. Cognitive testing included the mini-mental state examination (MMSE) and the vascular dementia assessment scale (VaDAS-cog).
One hundred forty-one (77.5%) patients had infratentorial abnormalities: 119 (65.4%) had focal infratentorial vascular lesions, 65 (35.7%) had diffuse pontine vascular abnormalities hyperintense on T2-weighted images, 20 (11.0%) had midbrain atrophy, and 16 (8.8%) had cerebellar atrophy. Significant correlations were found between number of infratentorial vascular lesions and basilar artery diameter (rs=0.26; P<0.0001), infratentorial and basal ganglia (including thalamus) vascular abnormalities (rs=0.30; P<0.0001), as well as between midbrain atrophy and global supratentorial atrophy (rs=0.27; P<0.0001). Infratentorial vascular abnormalities and cerebellar atrophy were not significantly associated with cognitive impairment. Patients with midbrain atrophy performed worse on cognitive tests than those without midbrain atrophy. After correction for sex, age, education, supratentorial abnormalities, and center, midbrain atrophy remained significantly associated with lower MMSE scores (P<0.05).
Infratentorial abnormalities often occur in patients with VaD, but only midbrain atrophy was found to be relevant to cognition.
幕下异常可能导致认知缺陷，但目前血管性痴呆（VaD）的研究标准未将其纳入考虑。我们的目的是确定VaD患者幕下异常的患病率、它们与幕上异常的关系，以及它们是否与认知相关。
我们对纳入一项多中心临床试验的182例可能患有VaD的患者（120例男性，平均年龄 = 73岁，标准差 = 8）进行了检查。对MRI扫描评估幕下血管异常、中脑萎缩、小脑萎缩、基底动脉直径和迂曲情况以及幕上异常。认知测试包括简易精神状态检查表（MMSE）和血管性痴呆评估量表（VaDAS - cog）。
141例（77.5%）患者存在幕下异常：119例（65.4%）有局灶性幕下血管病变，65例（35.7%）在T2加权图像上有弥漫性脑桥血管异常高信号，20例（11.0%）有中脑萎缩，16例（8.8%）有小脑萎缩。幕下血管病变数量与基底动脉直径之间（rs = 0.26；P < 0.0001）、幕下与基底节（包括丘脑）血管异常之间（rs = 0.30；P < 0.0001）以及中脑萎缩与全幕上萎缩之间（rs = 0.27；P < 0.0001）均存在显著相关性。幕下血管异常和小脑萎缩与认知障碍无显著关联。有中脑萎缩的患者在认知测试中的表现比无中脑萎缩的患者差。在校正性别、年龄、教育程度、幕上异常和中心因素后，中脑萎缩仍与较低的MMSE评分显著相关（P < 0.05）。
幕下异常在VaD患者中经常出现，但仅发现中脑萎缩与认知相关。
