血管负担是否会导致轻度认知障碍向痴呆发展？

Does vascular burden contribute to the progression of mild cognitive impairment to dementia?

机构信息

Center for Research and Treatment of Cognitive Dysfunctions, Institute of Clinical Neurology, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy.

出版信息

Dement Geriatr Cogn Disord. 2012;34(3-4):235-43. doi: 10.1159/000343776. Epub 2012 Nov 10.

DOI:10.1159/000343776

PMID:23147614

Abstract

AIMS

To investigate the contribution of vascular risk factors (VRFs), vascular diseases (VDs) and white matter lesions (WMLs) to the progression of mild cognitive impairment (MCI) to dementia and Alzheimer's disease (AD).

METHODS

Two hundred forty-five consecutive subjects with MCI (age 74.09 ± 6.92 years) were followed for an average of 2.4 years. The Hachinski Ischemic Score and the Framingham Stroke Risk Profile were used to summarize VRFs and VDs. WMLs were graded using the Age-Related White Matter Changes Scale.

RESULTS

One hundred twenty-nine (52.6%) out of 245 subjects at risk converted to dementia, including 87 cases of AD. When hypertension occurred in MCI with deep WMLs, a 1.8-fold increased risk of dementia was observed (95% CI = 1.0-3.4). When deep WMLs occurred in MCI with high scores (≥4) on the Hachinski scale, a 3.5-fold (95% CI = 1.6-7.4) and 3.8-fold (95% CI = 1.2-11.5) risk of progression to dementia and AD was observed, respectively. Analogously, the joint effect of WMLs and high scores (≥14) on the Framingham scale nearly doubled the risk of dementia (hazard ratio = 1.9, 95% CI = 1.1-3.3).

CONCLUSIONS

Accelerated progression of MCI to dementia and AD is to be expected when VRFs and VDs occur together with WMLs.

摘要

目的

研究血管危险因素（VRF）、血管疾病（VD）和脑白质病变（WML）对轻度认知障碍（MCI）向痴呆和阿尔茨海默病（AD）进展的影响。

方法

对 245 例连续 MCI 患者（年龄 74.09 ± 6.92 岁）进行平均 2.4 年的随访。采用 Hachinski 缺血评分和 Framingham 卒中风险评分来总结 VRF 和 VD。使用年龄相关的脑白质改变量表对 WML 进行分级。

结果

245 例有风险的患者中，129 例（52.6%）发展为痴呆，包括 87 例 AD。当 MCI 伴有深部 WML 且存在高血压时，痴呆的风险增加 1.8 倍（95%CI=1.0-3.4）。当 MCI 伴有深部 WML 且 Hachinski 评分≥4 时，进展为痴呆和 AD 的风险分别增加 3.5 倍（95%CI=1.6-7.4）和 3.8 倍（95%CI=1.2-11.5）。类似地，WML 与 Framingham 评分≥14 联合作用，痴呆的风险增加近 1.9 倍（危险比=1.9，95%CI=1.1-3.3）。