Department of Neurology, Alzheimer's Disease Center, Boston University School of Medicine, 72 E Concord St, B-7800, Boston, MA 02118, USA.
Circulation. 2010 Aug 17;122(7):690-7. doi: 10.1161/CIRCULATIONAHA.109.905091. Epub 2010 Aug 2.
Cardiac dysfunction is associated with neuroanatomic and neuropsychological changes in aging adults with prevalent cardiovascular disease, theoretically because systemic hypoperfusion disrupts cerebral perfusion, contributing to subclinical brain injury. We hypothesized that cardiac function, as measured by cardiac index, would be associated with preclinical brain magnetic resonance imaging (MRI) and neuropsychological markers of ischemia and Alzheimer disease in the community.
Brain MRI, cardiac MRI, neuropsychological, and laboratory data were collected on 1504 Framingham Offspring Cohort participants free of clinical stroke, transient ischemic attack, or dementia (age, 61+/-9 years; 54% women). Neuropsychological and brain MRI variables were related to cardiac MRI-assessed cardiac index (cardiac output/body surface area). In multivariable-adjusted models, cardiac index was positively related to total brain volume (P=0.03) and information processing speed (P=0.02) and inversely related to lateral ventricular volume (P=0.048). When participants with clinically prevalent cardiovascular disease were excluded, the relation between cardiac index and total brain volume remained (P=0.02). Post hoc comparisons revealed that participants in the bottom cardiac index tertile (values <2.54) and middle cardiac index tertile (values between 2.54 and 2.92) had significantly lower brain volumes (P=0.04) than participants in the top cardiac index tertile (values >2.92).
Although observational data cannot establish causality, our findings are consistent with the hypothesis that decreasing cardiac function, even at normal cardiac index levels, is associated with accelerated brain aging.
心脏功能障碍与患有常见心血管疾病的老年人群的神经解剖和神经心理学变化有关，理论上是因为全身低灌注会破坏脑灌注，导致亚临床脑损伤。我们假设，通过心脏指数测量的心脏功能与社区中临床前脑磁共振成像（MRI）和缺血性及阿尔茨海默病的神经心理学标志物相关。
在无临床中风、短暂性脑缺血发作或痴呆的弗雷明汉后代队列 1504 名参与者中（年龄 61+/-9 岁，54%为女性），收集了脑 MRI、心脏 MRI、神经心理学和实验室数据。神经心理学和脑 MRI 变量与心脏 MRI 评估的心脏指数（心输出量/体表面积）相关。在多变量调整模型中，心脏指数与总脑容量呈正相关（P=0.03），与信息处理速度呈正相关（P=0.02），与侧脑室容量呈负相关（P=0.048）。当排除患有临床常见心血管疾病的参与者后，心脏指数与总脑容量之间的关系仍然存在（P=0.02）。事后比较显示，心脏指数处于较低三分位（<2.54）和中等三分位（2.54-2.92）的参与者的脑容量明显低于心脏指数处于较高三分位（>2.92）的参与者（P=0.04）。
尽管观察性数据不能确立因果关系，但我们的发现与假设一致，即心脏功能下降，即使在正常心脏指数水平下，也与加速大脑衰老有关。
