Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
J Geriatr Psychiatry Neurol. 2012 Jun;25(2):122-7. doi: 10.1177/0891988712445089.
Prior research has shown that the total amount of white matter ischemia had no significant correlation with cognitive deficits. We compared the association of white matter hyperintensities (WMHs) of total as well as cholinergic pathways with clinical dementia severity and investigated whether cholinergic ischemic burden had an independent predictive value with respect to cognitive decline in subcortical vascular cognitive impairment (SVCI). Forty-eight patients underwent detailed neuropsychological tests and brain magnetic resonance imaging. Quantification of WMH in the total white matter and in cholinergic pathways was achieved using the visual Scheltens scale and Cholinergic Pathway HyperIntensity Scale (CHIPS), respectively. We explored the association between WMH scores and clinical dementia rating scale (CDR). To assess the relation between WMH and cognitive scores, multiple linear regression analysis was used. The CHIPS score was higher in subcortical vascular dementia compared to subcortical vascular MCI, while this difference was not found with the total TMHs (TWMH) score. The TWMH score had a positive correlation with CHIPS, however only CHIPS scores positively correlated with sum of box scores of CDR scale (CDR SB; ρ = .474, P = .001). Higher CHIPS scores were associated with lower performance on the semantic word fluency test (β = -.447, P = .036), whereas the TWMH scores had no independent predictive value with respect to cognitive impairment, after controlling for CHIPS score. Our data confirmed the association of ischemic damage within cholinergic pathways with dementia severity, independent of TWMH in SVCI. In addition, this cholinergic deficit is clinically relevant to cognitive deterioration, especially with frontal dysfunction.
先前的研究表明，脑白质总缺血量与认知缺陷无显著相关性。我们比较了脑白质高信号（WMH）总量以及胆碱能通路与临床痴呆严重程度的相关性，并研究了胆碱能性缺血负担是否对皮质下血管性认知障碍（SVCI）的认知下降具有独立的预测价值。48 名患者接受了详细的神经心理学测试和脑磁共振成像。WMH 总量和胆碱能通路的定量采用视觉 Scheltens 量表和胆碱能通路高信号量表（CHIPS）分别进行。我们探讨了 WMH 评分与临床痴呆评定量表（CDR）之间的关系。为了评估 WMH 与认知评分之间的关系，采用多元线性回归分析。与皮质下血管性 MCI 相比，皮质下血管性痴呆的 CHIPS 评分更高，而 TWMH 总分（TWMH）评分则没有差异。TWMH 评分与 CHIPS 呈正相关，但只有 CHIPS 评分与 CDR 总分的箱式评分呈正相关（ρ=0.474，P=0.001）。较高的 CHIPS 评分与语义流畅性测试的表现呈负相关（β=-0.447，P=0.036），而 TWMH 评分在控制 CHIPS 评分后，对认知障碍无独立的预测价值。我们的数据证实了胆碱能通路内缺血性损伤与 SVCI 中痴呆严重程度的相关性，与 TWMH 无关。此外，这种胆碱能缺陷与认知恶化有关，尤其是与额叶功能障碍有关。
