Basile Anna Maria, Pantoni Leonardo, Pracucci Giovanni, Asplund Kjell, Chabriat Hugues, Erkinjuntti Timo, Fazekas Franz, Ferro José M, Hennerici Michael, O'Brien John, Scheltens Philip, Visser Marieke C, Wahlund Lars-Olof, Waldemar Gunhild, Wallin Anders, Inzitari Domenico
Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy, and Department of Neurology, Hôpital Lariboisière, Paris, France.
Cerebrovasc Dis. 2006;21(5-6):315-22. doi: 10.1159/000091536. Epub 2006 Feb 14.
Age-related white matter changes (ARWMC), seen on neuroimaging with high frequency in older people, are thought to be consequent to the effect of vascular risk factors and vascular diseases including hypertension and stroke. Among the proofs conventionally required for a factor to be considered a risk factor for a definite pathology, there is the demonstration of a trend in risk exposure related to disease severity. We sought whether such a trend existed in the association of vascular risk factors or comorbidities with the severity of ARWMC aiming particularly at further elucidating the relative roles of hypertension and stroke in this regard.
The LADIS (Leukoaraiosis and Disability) Study is evaluating the role of ARWMC as an independent determinant of the transition to disability in the elderly. Six hundred and thirty-nine nondisabled subjects (mean age 74.1+/-5.0, M/F: 288/351) with ARWMC of different severity grades on MRI (mild, moderate, or severe according to the Fazekas scale) were assessed at baseline for demographics, vascular risk factors, and comorbidities, and are being followed up for 3 years.
Age, frequency of hypertension and history of stroke increased along with increasing ARWMC severity independently of other factors. For hypertension, however, this occurred only in subjects without a stroke history, while for stroke history, it mainly depended on lacunar stroke. The amount of cigarettes smoked and the interaction between hypercholesterolemia and smoking predicted only the most severe ARWMC grade.
The LADIS Study confirms that age, hypertension and lacunar strokes are the major determinants of ARWMC. Smoking and hypercholesterolemia provide additional risk.
年龄相关性白质改变（ARWMC）在老年人的神经影像学检查中高频出现，被认为是血管危险因素及包括高血压和中风在内的血管疾病作用的结果。在一个因素被认为是某种特定病理状态的危险因素通常所需的证据中，有风险暴露与疾病严重程度相关趋势的证明。我们探究血管危险因素或合并症与ARWMC严重程度之间是否存在这样一种趋势，尤其旨在进一步阐明高血压和中风在这方面的相对作用。
LADIS（脑白质疏松症与残疾）研究正在评估ARWMC作为老年人向残疾转变的独立决定因素的作用。对639名无残疾受试者（平均年龄74.1±5.0岁，男/女：288/351）进行了研究，这些受试者MRI显示有不同严重程度等级的ARWMC（根据 Fazekas量表分为轻度、中度或重度），在基线时评估其人口统计学特征、血管危险因素和合并症，并进行3年的随访。
年龄、高血压发生率和中风病史随ARWMC严重程度增加而升高，且独立于其他因素。然而，对于高血压，这种情况仅发生在无中风病史的受试者中，而对于中风病史，其主要取决于腔隙性中风。吸烟量以及高胆固醇血症与吸烟之间的相互作用仅能预测最严重的ARWMC等级。
LADIS研究证实年龄、高血压和腔隙性中风是ARWMC的主要决定因素。吸烟和高胆固醇血症会增加风险。
