Pantoni Leonardo, Poggesi Anna, Inzitari Domenico
Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy.
Curr Opin Neurol. 2007 Aug;20(4):390-7. doi: 10.1097/WCO.0b013e328172d661.
To summarize recent findings and developments in the field of the relation between white-matter lesions and cognition.
Recent studies have provided further evidence that white-matter lesions exert a detrimental effect on cognitive profile. New magnetic-resonance techniques may help in clarifying the meaning and extent of this effect. Evidence is also increasing about lesion progression occurring over time, at least in patients with severe white-matter lesions, and this progression is one of the factors related to cognitive decline in the elderly. The need to delay or halt the progression of white-matter lesions has led to clarification of the role of some risk factors and to performance of therapeutic trials where white-matter lesions are used as a surrogate marker for the end point of small-vessel disease. In addition to cognitive effects, white-matter lesions have a role in the decline of other functional performances, and this places individuals with higher-grade lesions at increased risk of developing disability.
White-matter lesions cannot be considered as mere incidental findings, at least in patients who show severe lesions. The pathogenesis of white-matter lesions must be clarified further and strategies found to delay their progression.
总结白质病变与认知关系领域的最新研究结果和进展。
近期研究进一步证明白质病变对认知状况有不利影响。新的磁共振技术可能有助于阐明这种影响的意义和程度。关于白质病变随时间推移发生进展的证据也在增加，至少在患有严重白质病变的患者中如此，而且这种进展是与老年人认知衰退相关的因素之一。延缓或阻止白质病变进展的需求促使人们明确了一些危险因素的作用，并开展了将白质病变用作小血管疾病终点替代标志物的治疗试验。除了认知影响外，白质病变在其他功能表现衰退中也起作用，这使患有更高级别病变的个体发生残疾的风险增加。
至少在患有严重病变的患者中，白质病变不能被视为单纯的偶然发现。必须进一步阐明白质病变的发病机制，并找到延缓其进展的策略。
