Kim H J, Ye B S, Yoon C W, Noh Y, Kim G H, Cho H, Jeon S, Lee J M, Kim J-H, Seong J-K, Kim C-H, Choe Y S, Lee K H, Kim S T, Kim J S, Park S E, Kim J-H, Chin J, Cho J, Kim C, Lee J H, Weiner M W, Na D L, Seo S W
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Eur J Neurol. 2014 May;21(5):744-51. doi: 10.1111/ene.12376. Epub 2014 Feb 4.
The progression pattern of brain structural changes in patients with isolated cerebrovascular disease (CVD) remains unclear. To investigate the role of isolated CVD in cognitive impairment patients, patterns of cortical thinning and hippocampal atrophy in pure subcortical vascular mild cognitive impairment (svMCI) and pure subcortical vascular dementia (SVaD) patients were characterized.
Forty-five patients with svMCI and 46 patients with SVaD who were negative on Pittsburgh compound B (PiB) positron emission tomography imaging and 75 individuals with normal cognition (NC) were recruited.
Compared with NC, patients with PiB(-) svMCI exhibited frontal, language and retrieval type memory dysfunctions, which in patients with PiB(-) SVaD were further impaired and accompanied by visuospatial and recognition memory dysfunctions. Compared with NC, patients with PiB(-) svMCI exhibited cortical thinning in the frontal, perisylvian, basal temporal and posterior cingulate regions. This atrophy was more prominent and extended further toward the lateral parietal and medial temporal regions in patients with PiB(-) SVaD. Compared with NC subjects, patients with PiB(-) svMCI exhibited hippocampal shape deformities in the lateral body, whilst patients with PiB(-) SVaD exhibited additional deformities within the lateral head and inferior body.
Our findings suggest that patients with CVD in the absence of Alzheimer's disease pathology can be demented, showing cognitive impairment in multiple domains, which is consistent with the topography of cortical thinning and hippocampal shape deformity.
孤立性脑血管疾病（CVD）患者脑结构变化的进展模式仍不清楚。为了研究孤立性CVD在认知障碍患者中的作用，对纯皮质下血管性轻度认知障碍（svMCI）和纯皮质下血管性痴呆（SVaD）患者的皮质变薄和海马萎缩模式进行了特征分析。
招募了45例匹兹堡化合物B（PiB）正电子发射断层扫描成像阴性的svMCI患者、46例SVaD患者以及75名认知正常（NC）的个体。
与NC组相比，PiB（-）svMCI患者表现出额叶、语言和检索型记忆功能障碍，PiB（-）SVaD患者的这些功能障碍进一步受损，并伴有视觉空间和识别记忆功能障碍。与NC组相比，PiB（-）svMCI患者在额叶、岛周、颞叶基底和后扣带回区域出现皮质变薄。在PiB（-）SVaD患者中，这种萎缩更为明显，并进一步向外侧顶叶和内侧颞叶区域扩展。与NC组受试者相比，PiB（-）svMCI患者在海马体外侧出现形态畸形，而PiB（-）SVaD患者在海马体外侧头部和下侧身体还出现了额外的畸形。
我们的研究结果表明，在没有阿尔茨海默病病理改变的情况下，CVD患者可能会出现痴呆，表现为多个领域的认知障碍，这与皮质变薄和海马形态畸形的部位一致。
