Departament of Psychiatry, University of Sao Paulo Medical School, SP, Brazil. tania
J Alzheimers Dis. 2011;27(3):575-89. doi: 10.3233/JAD-2011-110827.
Vascular risk factors may play an important role in the pathophysiology of Alzheimer's disease (AD). While there is consistent evidence of gray matter (GM) abnormalities in earlier stages of AD, the presence of more subtle GM changes associated with vascular risk factors in the absence of clinically significant vascular events has been scarcely investigated. This study aimed to examine GM changes in elderly subjects with cardiovascular risk factors. We predicted that the presence of cardiovascular risk would be associated with GM abnormalities involving the temporal-parietal cortices and limbic structures. We recruited 248 dementia-free subjects, age range 66-75 years, from the population-based "São Paulo Ageing and Health Study", classified in accordance to their Framingham Coronary Heart Disease Risk (FCHDR) score to undergo an MRI scan. We performed an overall analysis of covariance, controlled to total GM and APOE4 status, to investigate the presence of regional GM abnormalities in association with FCHDR subgroups (high-risk, medium-risk, and low-risk), and followed by post hoc t-test. We also applied a co-relational design in order to investigate the presence of linear progression of the GM vulnerability in association with cardiovascular risk factor. Voxel-based morphometry showed that the presence of cardiovascular risk factors were associated with regional GM loss involving the temporal cortices bilaterally. Those results retained statistical significance after including APOE4 as a covariate of interest. We also observed that there was a negative correlation between FCHDR scores and rGM distribution in the parietal cortex. Subclinical cerebrovascular abnormalities involving GM loss may provide an important link between cardiovascular risk factors and AD.
血管危险因素可能在阿尔茨海默病（AD）的病理生理学中起重要作用。虽然在 AD 的早期阶段有一致的证据表明存在灰质（GM）异常，但在没有临床显著血管事件的情况下，与血管危险因素相关的更微妙的 GM 变化的存在尚未得到充分研究。本研究旨在检查有心血管危险因素的老年患者的 GM 变化。我们预测心血管危险因素的存在将与颞顶叶皮层和边缘结构相关的 GM 异常有关。我们从基于人群的“圣保罗衰老与健康研究”中招募了 248 名无痴呆的受试者，年龄在 66-75 岁之间，根据他们的弗雷明汉冠心病风险（FCHDR）评分进行分类，以进行 MRI 扫描。我们进行了总体协方差分析，控制了总 GM 和 APOE4 状态，以研究与 FCHDR 亚组（高风险、中风险和低风险）相关的局部 GM 异常的存在，并随后进行了事后 t 检验。我们还应用了相关设计，以研究与心血管危险因素相关的 GM 脆弱性的线性进展的存在。体素形态计量学显示，存在心血管危险因素与双侧颞叶皮质的区域性 GM 损失有关。在将 APOE4 作为感兴趣的协变量包括在内后，这些结果仍然具有统计学意义。我们还观察到 FCHDR 评分与顶叶皮层 rGM 分布之间存在负相关。涉及 GM 损失的亚临床脑血管异常可能为心血管危险因素与 AD 之间提供重要联系。
