Stenset V, Johnsen L, Kocot D, Negaard A, Skinningsrud A, Gulbrandsen P, Wallin A, Fladby T
Department of Neurology, Akershus University Hospital, Sykehusveien 27, NO-1478 Lørenskog, Norway.
Neurology. 2006 Sep 12;67(5):830-3. doi: 10.1212/01.wnl.0000234030.77831.5a.
To analyze a putative relationship between white matter lesions (WMLs), risk factors for WMLs, and Alzheimer disease (AD) as measured with the surrogate marker CSF Abeta42.
The authors analyzed effects of acquired risk factors for cerebrovascular disease and WMLs on AD as measured with an intermediate marker, CSF Abeta42. A total of 127 consecutive patients with subjective memory impairment (mean age 66 years; 57 women) investigated at a university-based memory clinic had brain MRI scans. WMLs were rated on a 12-point scale with a semiquantitative procedure. They used path analysis with established and possible risk factors for WMLs and for reduced CSF Abeta42 (age, hypertension, hyperhomocysteinemia, hypercholesterolemia, APOE-epsilon4) as variables.
The WML score was 1.5 points higher (p < 0.05) in hypertensive than in nonhypertensive patients and 1.9 points higher (p < 0.05) in patients with hyperhomocysteinemia than in those with normal homocysteine levels. Hypercholesterolemia increased the probability of low CSF Abeta42 levels by 0.2 (p < 0.05). For each point increase in WML score, the probability of low CSF Abeta42 levels increased by 0.03 (p < 0.05). APOE-epsilon4 was associated with reduced CSF Abeta42 (p < 0.01).
Both hypercholesterolemia and white matter lesions may contribute to low CSF Abeta42 by independent mechanisms.
分析白质病变（WMLs）、WMLs的危险因素与阿尔茨海默病（AD）之间的假定关系，以脑脊液β淀粉样蛋白42（CSF Abeta42）作为替代标志物进行测量。
作者分析了脑血管疾病和WMLs的获得性危险因素对AD的影响，以中间标志物CSF Abeta42进行测量。在一家大学记忆诊所对127例连续的主观记忆障碍患者（平均年龄66岁；57名女性）进行了脑磁共振成像扫描。采用半定量程序对WMLs进行12分制评分。他们将已确定的和可能的WMLs及CSF Abeta42降低的危险因素（年龄、高血压、高同型半胱氨酸血症、高胆固醇血症、APOE-ε4）作为变量进行路径分析。
高血压患者的WML评分比非高血压患者高1.5分（p<0.05），高同型半胱氨酸血症患者的WML评分比同型半胱氨酸水平正常的患者高1.9分（p<0.05）。高胆固醇血症使CSF Abeta42水平降低的概率增加0.2（p<0.05）。WML评分每增加1分，CSF Abeta42水平降低的概率增加0.03（p<0.05）。APOE-ε4与CSF Abeta42降低相关（p<0.01）。
高胆固醇血症和白质病变可能通过独立机制导致CSF Abeta42水平降低。
