Inserm, U708 Neuroepidemiology, Paris, France.
J Alzheimers Dis. 2010;20(2):453-63. doi: 10.3233/JAD-2010-1389.
Several brain magnetic resonance imaging (MRI) changes are observed in older individuals including white matter lesions (WML), silent brain infarcts (SBI), and cerebral atrophy. Few studies, however, have assessed the combined association of these changes on the severity of future cognitive decline. In the prospective population-based 3C-Dijon MRI study, 1701 non-demented participants aged 65 to 80 years at entry had a brain MRI. Information on WML, hippocampal volumes, SBI presence, and brain parenchymal fraction were obtained. At 4-year follow-up, participants were screened for cognitive decline and dementia. Severity of cognitive decline was defined as none, moderate, or severe calculated from neuropsychological test performance change. The relation between brain MRI markers and longitudinal change in cognition was studied using polytomous logistic regression and multiple linear regression models controlling for potential confounders. Two-by-two interactions were tested including with the apolipoprotein E genotype. At follow-up, 46 participants showed severe cognitive deterioration and 224 participants showed moderate cognitive deterioration. In multivariable analyses, risk of severe cognitive deterioration as well as the cognitive decline rate were significantly increased in participants with higher WML volume (p< 0.01) and smaller hippocampal volume (p< 0.01). The results suggested that WML and hippocampal volumes had a cumulative effect on the future level of cognitive decline. The APOE genotype was found to be an effect modifier of this association. Vascular brain changes and degenerative processes coexist in normal older individuals. The co-occurrence of degenerative and non-degenerative pathologies could strongly affect the course of dementia expression.
几项脑磁共振成像（MRI）变化在老年人中观察到，包括白质病变（WML）、无症状性脑梗死（SBI）和脑萎缩。然而，很少有研究评估这些变化对未来认知能力下降严重程度的综合关联。在前瞻性人群基础的 3C-Dijon MRI 研究中，1701 名年龄在 65 至 80 岁的非痴呆参与者在入组时进行了脑部 MRI。获得了 WML、海马体体积、SBI 存在和脑实质分数的信息。在 4 年的随访中，对参与者进行了认知能力下降和痴呆的筛查。认知能力下降的严重程度定义为从神经心理学测试表现变化计算出的无、中度或重度。使用多分类逻辑回归和多线性回归模型，在控制潜在混杂因素的情况下，研究了脑 MRI 标志物与认知纵向变化之间的关系。测试了包括载脂蛋白 E 基因型在内的 2×2 交互作用。在随访中，46 名参与者表现出严重的认知恶化，224 名参与者表现出中度认知恶化。在多变量分析中，较高的 WML 体积（p<0.01）和较小的海马体体积（p<0.01）的参与者，发生严重认知恶化的风险以及认知衰退的速度显著增加。结果表明，WML 和海马体体积对未来认知下降水平有累积影响。APOE 基因型被发现是这种关联的效应修饰剂。血管性脑改变和退行性过程在正常老年人中同时存在。退行性和非退行性病理的共同发生可能强烈影响痴呆表达的过程。
