一项针对老年心血管疾病患者言语工作记忆、心输出量和射血分数的功能磁共振成像研究。
A fMRI Study of Verbal Working Memory, Cardiac Output, and Ejection Fraction in Elderly Patients with Cardiovascular Disease.
作者信息
Irani Farzin, Sweet Lawrence H, Haley Andreana P, Gunstad John J, Jerskey Beth A, Mulligan Richard C, Jefferson Angela L, Poppas Athena, Cohen Ronald A
机构信息
Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA. Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Brain Imaging Behav. 2009 Dec;3(4):350-357. doi: 10.1007/s11682-009-9077-0.
Cardiovascular disease (CVD) is associated with cognitive deficits even in the absence of stroke. We examined the relationship between cardiac performance, as measured by cardiac output (CO) and ejection fraction (EF), and brain activity during a verbal working memory (VWM) task in elderly CVD patients who tend to be at increased risk for vascular cognitive impairments. Seventeen patients were recruited from a cohort participating in an ongoing prospective study examining the effects of CVD on cognitive function in the elderly. Participants were diagnosed with CVD (age 68±8) and completed a 2-back VWM task in a 1.5T fMRI paradigm. CO and EF were calculated from echocardiogram measures. Task-related activation was averaged in a priori regions of interest. The relationship between CO, EF, and 2-back-related activity was modeled using partial correlations (two-tailed p<.05) controlling for age and 2-back accuracy. All participants were globally cognitively intact as indicated by Mini-Mental Status Exam and Dementia Rating Scale scores. Mean accuracy on the 2-back was 78±9% while reaction time averaged 1,027±192 ms. Mean CO and EF values showed a large range (CO: 3.55 to 6.31; EF: 0.36 to 0.76) but average values were within the normal range. After controlling for age and 2-back accuracy, lower EF was related to decrease in left insula activity (r=0.61, p=0.03). There were trends for EF to be related to accuracy (r=0.47, p=0.09) and reaction time (r=-0.48, p=0.09). CO was also related to insula activity (r=0.60, p=0.04) and activity in the supplementary motor area activity (r=0.66, p=0.01). Cardiac performance was related to decreased efficiency in task related brain areas and tended to be related to performance on a VWM task in elderly patients with CVD. Results have implications for a line of investigation indicating that cardiac and systemic vascular indices could be used as proxy measures to examine mechanisms of cerebrovascular dysfunction in the elderly.
心血管疾病（CVD）即使在没有中风的情况下也与认知缺陷有关。我们在有血管性认知障碍风险增加的老年CVD患者的言语工作记忆（VWM）任务期间，研究了以心输出量（CO）和射血分数（EF）衡量的心脏功能与大脑活动之间的关系。从参与一项正在进行的前瞻性研究的队列中招募了17名患者，该研究考察CVD对老年人认知功能的影响。参与者被诊断患有CVD（年龄68±8岁），并在1.5T功能磁共振成像范式下完成了一项2-back VWM任务。CO和EF通过超声心动图测量计算得出。任务相关激活在预先设定的感兴趣区域进行平均。使用偏相关（双尾p<0.05）对年龄和2-back准确性进行控制，对CO、EF和2-back相关活动之间的关系进行建模。如简易精神状态检查和痴呆评定量表得分所示，所有参与者在整体认知上均完好无损。2-back任务的平均准确率为78±9%，而反应时间平均为1027±192毫秒。平均CO和EF值显示出较大范围（CO：3.55至6.31；EF：0.36至0.76），但平均值在正常范围内。在控制年龄和2-back准确性后，较低的EF与左岛叶活动减少有关（r=0.61，p=0.03）。EF有与准确率相关（r=0.47，p=0.09）和与反应时间相关（r=-0.48，p=0.09）的趋势。CO也与岛叶活动（r=0.60，p=0.04）和辅助运动区活动（r=0.66，p=0.01）有关。心脏功能与老年CVD患者任务相关脑区的效率降低有关，并且倾向于与VWM任务的表现有关。研究结果对一系列调查有启示意义，表明心脏和全身血管指标可作为替代指标来研究老年人脑血管功能障碍的机制。
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