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Stroke. 2010 May;41(5):891-7. doi: 10.1161/STROKEAHA.110.579581. Epub 2010 Apr 1.
Several cardiovascular risk factors are associated with cognitive disorders in older persons. Little is known about the association of the burden of coronary atherosclerosis with brain structure and function.
This is a cross-sectional analysis of data from the Age, Gene, Environment Susceptibility (AGES)-Reykjavik Study cohort of men and women born 1907 to 1935. Coronary artery calcification (CAC), a marker of atherosclerotic burden, was measured with CT. Memory, speed of processing, and executive function composites were calculated from a cognitive test battery. Dementia was assessed in a multistep procedure and diagnosed according to international guidelines. Quantitative data on total intracranial and tissue volumes (total, gray matter volume, white matter volume, and white matter lesion volume), cerebral infarcts, and cerebral microbleeds were obtained with brain MRI. The association of CAC with dementia (n=165 cases) and cognitive function in nondemented subjects (n=4085), and separately with MRI outcomes, was examined in multivariate models adjusting for demographic and vascular risk factors. Analyses tested whether brain structure mediated the associations of CAC to cognitive function.
Subjects with higher CAC were more likely to have dementia and lower cognitive scores, more likely to have lower white matter volume, gray matter volume, and total brain tissue, and to have more cerebral infarcts, cerebral microbleeds, and white matter lesions. The relations of cognitive performance and dementia to CAC were significantly attenuated when the models were adjusted for brain lesions and volumes.
In a population-based sample, increasing atherosclerotic load assessed by CAC is associated with poorer cognitive performance and dementia, and these relations are mediated by evidence of brain pathology.
多种心血管危险因素与老年人认知障碍有关。然而,冠状动脉粥样硬化负担与大脑结构和功能之间的关联却知之甚少。
这是一项横断面分析,数据来自 Age, Gene, Environment Susceptibility (AGES)-Reykjavik 研究队列中的男性和女性,他们出生于 1907 年至 1935 年。冠状动脉钙化(CAC)是动脉粥样硬化负担的标志物,通过 CT 进行测量。从认知测试组合中计算出记忆、处理速度和执行功能的综合得分。痴呆症通过多步骤程序进行评估,并根据国际指南进行诊断。脑 MRI 获得了总颅内和组织体积(总量、灰质体积、白质体积和白质病变体积)、脑梗死和脑微出血的定量数据。在多变量模型中,调整了人口统计学和血管危险因素后,对 CAC 与痴呆症(n=165 例)和认知功能正常的受试者(n=4085 例)之间的关联,以及与 MRI 结果之间的关联进行了检查。分析测试了 CAC 与认知功能的关联是否通过大脑结构进行介导。
CAC 较高的受试者更有可能患有痴呆症和认知评分较低,更有可能出现较低的白质体积、灰质体积和总脑组织量,并且更有可能出现脑梗死、脑微出血和白质病变。当模型调整为脑病变和体积时,认知表现和痴呆与 CAC 的关系明显减弱。
在基于人群的样本中,CAC 评估的动脉粥样硬化负担增加与认知表现较差和痴呆症有关,而这些关系是通过大脑病理学的证据介导的。