Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, MD, USA.
Neurology. 2010 Dec 14;75(24):2221-8. doi: 10.1212/WNL.0b013e3182020349.
To determine whether microvascular damage, indicated by cerebral microbleeds (CMBs) and retinal microvascular signs, is associated with cognitive function and dementia in older persons.
This is a cross-sectional study of 3,906 participants (mean age 76 years; 58% women) in the AGES-Reykjavik Study (2002-2006). We assessed CMBs on MRI and retinal microvascular signs on digital retinal images. Composite Z scores of memory, processing speed, and executive function were derived from a battery of neurocognitive tests. Dementia and subtypes were diagnosed following international criteria. Regression models were used to relate cognitive Z scores and dementia to CMBs and retinal microvascular signs, adjusting for demographics, cardiovascular factors, and brain ischemic lesions.
People with multiple (≥ 2) CMBs had lower Z scores on tests of processing speed (β-coefficient -0.16; 95% confidence interval -0.26 to -0.05) and executive function (-0.14; -0.24 to -0.04); results were strongest for having multiple CMBs located in the deep hemispheric or infratentorial areas. The odds ratio of vascular dementia was 2.32 (95% confidence interval 1.02 to 5.25) for multiple CMBs and 1.95 (1.04 to 3.62) for retinopathy. Having both CMBs and retinopathy, compared to having neither, was significantly associated with markedly slower processing speed (-0.25; -0.37 to -0.12), poorer executive function (-0.19; -0.31 to -0.07), and an increased odds ratio of vascular dementia (3.10; 1.11 to 8.62).
Having multiple CMBs or concomitant CMBs and retinopathy is associated with a profile of vascular cognitive impairment. These findings suggest that microvascular damage, as indicated by CMBs and retinopathy lesions, has functional consequences in older men and women living in the community.
确定脑微出血 (CMBs) 和视网膜微血管征象等微血管损伤是否与老年人的认知功能和痴呆有关。
这是一项对年龄在 76 岁（58%为女性）的 3906 名 AGES-Reykjavik 研究参与者（2002-2006 年）的横断面研究。我们在 MRI 上评估 CMBs，并在数字视网膜图像上评估视网膜微血管征象。一系列神经认知测试的记忆、处理速度和执行功能综合 Z 评分。根据国际标准诊断痴呆和亚型。回归模型用于将认知 Z 评分和痴呆与 CMBs 和视网膜微血管征象相关联，调整人口统计学、心血管因素和脑缺血性病变。
有多个（≥2）CMBs 的人在处理速度（β系数-0.16；95%置信区间-0.26 至-0.05）和执行功能（-0.14；-0.24 至-0.04）的测试中得分较低；CMBs 位于深部半球或脑桥区域的情况最强。多发性 CMBs 的血管性痴呆比值比为 2.32（95%置信区间 1.02 至 5.25），视网膜病变为 1.95（1.04 至 3.62）。与既无 CMBs 又无视网膜病变相比，同时存在 CMBs 和视网膜病变与明显较慢的处理速度（-0.25；-0.37 至-0.12）、较差的执行功能（-0.19；-0.31 至-0.07）和血管性痴呆的比值比显著增加（3.10；1.11 至 8.62）相关。
多发性 CMBs 或同时存在 CMBs 和视网膜病变与血管性认知障碍的特征有关。这些发现表明，社区中生活的老年男性和女性的 CMBs 和视网膜病变等微血管损伤与功能后果有关。
