Poggesi Anna, Gouw Alida, van der Flier Wiesje, Pracucci Giovanni, Chabriat Hugues, Erkinjuntti Timo, Fazekas Franz, Ferro José M, Blahak Christian, Langhorne Peter, O'Brien John, Schmidt Reinhold, Visser Marieke C, Wahlund Lars-Olof, Waldemar Gunhild, Wallin Anders, Scheltens Philip, Inzitari Domenico, Pantoni Leonardo
Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy.
J Neurol. 2014 Jun;261(6):1160-9. doi: 10.1007/s00415-014-7332-9. Epub 2014 Apr 11.
To investigate the role of neurological abnormalities and magnetic resonance imaging (MRI) lesions in predicting global functional decline in a cohort of initially independent-living elderly subjects. The Leukoaraiosis And DISability (LADIS) Study, involving 11 European centres, was primarily aimed at evaluating age-related white matter changes (ARWMC) as an independent predictor of the transition to disability (according to Instrumental Activities of Daily Living scale) or death in independent elderly subjects that were followed up for 3 years. At baseline, a standardized neurological examination was performed. MRI assessment included age-related white matter changes (ARWMC) grading (mild, moderate, severe according to the Fazekas' scale), count of lacunar and non-lacunar infarcts, and global atrophy rating. Of the 633 (out of the 639 enrolled) patients with follow-up information (mean age 74.1 ± 5.0 years, 45 % males), 327 (51.7 %) presented at the initial visit with ≥1 neurological abnormality and 242 (38 %) reached the main study outcome. Cox regression analyses, adjusting for MRI features and other determinants of functional decline, showed that the baseline presence of any neurological abnormality independently predicted transition to disability or death [HR (95 % CI) 1.53 (1.01-2.34)]. The hazard increased with increasing number of abnormalities. Among MRI lesions, only ARWMC of severe grade independently predicted disability or death [HR (95 % CI) 2.18 (1.37-3.48)]. In our cohort, presence and number of neurological examination abnormalities predicted global functional decline independent of MRI lesions typical of the aging brain and other determinants of disability in the elderly. Systematically checking for neurological examination abnormalities in older patients may be cost-effective in identifying those at risk of functional decline.
旨在研究神经功能异常和磁共振成像（MRI）病变在预测一组最初独立生活的老年受试者整体功能衰退中的作用。白质疏松与残疾（LADIS）研究涉及11个欧洲中心，其主要目的是评估年龄相关性白质改变（ARWMC）作为独立生活的老年受试者向残疾转变（根据日常生活活动量表）或死亡的预测因素，这些受试者接受了3年的随访。在基线时，进行了标准化的神经学检查。MRI评估包括年龄相关性白质改变（ARWMC）分级（根据 Fazekas 量表分为轻度、中度、重度）、腔隙性和非腔隙性梗死灶计数以及整体萎缩评分。在639名入组患者中有633名（平均年龄74.1±5.0岁，45%为男性）有随访信息，其中327名（51.7%）在初次就诊时存在≥1项神经功能异常，242名（38%）达到主要研究结局。多因素Cox回归分析在调整了MRI特征和功能衰退的其他决定因素后显示，任何神经功能异常的基线存在情况可独立预测向残疾或死亡的转变[风险比（95%置信区间）1.53（1.01 - 2.34）]。风险随着异常数量的增加而升高。在MRI病变中，只有重度ARWMC可独立预测残疾或死亡[风险比（95%置信区间）2.18（1.37 - 3.48）]。在我们的队列中，神经学检查异常的存在情况和数量可独立于典型的老年脑MRI病变及老年人残疾的其他决定因素预测整体功能衰退。对老年患者系统地检查神经学检查异常情况在识别功能衰退风险人群方面可能具有成本效益。
