Murray Melissa E, Senjem Matthew L, Petersen Ronald C, Hollman John H, Preboske Greg M, Weigand Stephen D, Knopman David S, Ferman Tanis J, Dickson Dennis W, Jack Clifford R
Department of Neuroscience (Neuropathology), Mayo Clinic, Jacksonville, Florida, USA.
Arch Neurol. 2010 Nov;67(11):1379-85. doi: 10.1001/archneurol.2010.280.
To investigate the impact white matter hyperintensities (WMH) detected on magnetic resonance imaging have on motor dysfunction and cognitive impairment in elderly subjects without dementia.
Cross-sectional study.
Population-based study on the incidence and prevalence of cognitive impairment in Olmsted County, Minnesota.
A total of 148 elderly subjects (65 men) without dementia ranging in age from 73 to 91 years.
We measured the percentage of the total white matter volume classified as WMH in a priori-defined brain regions (ie, frontal, temporal, parietal, occipital, periventricular, or subcortical). Motor impairment was evaluated qualitatively using the Unified Parkinson's Disease Rating Scale summary measures of motor skills and quantitatively using a digitized portable walkway system. Four cognitive domains were evaluated using z scores of memory, language, executive function, and visuospatial reasoning.
A higher WMH proportion in all regions except the occipital lobe was associated with lower executive function z score (P value <.01). A higher WMH proportion in all regions, but most strongly for the parietal lobe, correlated with higher Unified Parkinson's Disease Rating Scale gait, posture, and postural stability sum (P value <.01). A higher WMH proportion, whether periventricular, subcortical, or lobar, correlated with reduced velocity (P value <.001).
We conclude that executive function is the primary cognitive domain affected by WMH burden. The data suggest that WMH in the parietal lobe are chiefly responsible for reduced balance and postural support compared with the other 3 lobes and may alter integration of sensory information via parietal lobe dysfunction in the aging brain. Parietal white matter changes were not the predominant correlate with motor speed, lending evidence to a global involvement of neural networks in gait velocity.
探讨磁共振成像检测到的白质高信号（WMH）对无痴呆老年受试者运动功能障碍和认知障碍的影响。
横断面研究。
明尼苏达州奥尔姆斯特德县基于人群的认知障碍发病率和患病率研究。
共有148名无痴呆的老年受试者（65名男性），年龄在73至91岁之间。
我们测量了先验定义脑区（即额叶、颞叶、顶叶、枕叶、脑室周围或皮质下）中归类为WMH的白质总体积百分比。使用统一帕金森病评定量表运动技能汇总指标对运动障碍进行定性评估，并使用数字化便携式步道系统进行定量评估。使用记忆、语言、执行功能和视觉空间推理的z分数评估四个认知领域。
除枕叶外，所有区域较高的WMH比例与较低的执行功能z分数相关（P值<.01）。所有区域较高的WMH比例，尤其是顶叶，与较高的统一帕金森病评定量表步态、姿势和姿势稳定性总和相关（P值<.01）。无论脑室周围、皮质下还是脑叶，较高的WMH比例都与速度降低相关（P值<.001）。
我们得出结论，执行功能是受WMH负担影响的主要认知领域。数据表明，与其他三个脑叶相比，顶叶的WMH是平衡和姿势支持降低的主要原因，并且可能通过衰老大脑中顶叶功能障碍改变感觉信息的整合。顶叶白质变化与运动速度并非主要相关，这为神经网络在步态速度中的整体参与提供了证据。
