Pavlovic Aleksandra M, Pekmezovic Tatjana, Tomic Gordana, Trajkovic Jasna Zidverc, Sternic Nada
University of Belgrade, Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
J Alzheimers Dis. 2014;42 Suppl 3:S37-43. doi: 10.3233/JAD-132606.
Cerebral small vessel disease (SVD) is a common cause of cognitive impairment and vascular dementia.
We aimed to investigate predictors of cognitive decline in patients with SVD who initially presented with first-ever small subcortical stroke of lacunar type but had normal cognitive status.
A total of 294 patients with SVD were evaluated 3-5 years after initial presentation. We analyzed baseline demographic data, vascular risk factors, functional status expressed as score on modified Rankin Scale, total number of lacunar infarcts, and severity of white matter hyperintensities (WMH) on magnetic resonance imaging with Age-Related White Matter Changes scale total score (tARWMC) and Fazekas scale periventricular and deep subcortical scores.
At follow-up, vascular cognitive impairment (VCI) on any type was detected in 188 (63.9%) of SVD patients, with 65 (22.1%) meeting criteria for vascular dementia and 123 (41.8%) presenting with cognitive impairment not dementia. Patients with VCI were older (64.4 ± 10.3 in VCI versus 58.6 ± 10.5 years in non-VCI; p < 0.0001) at the time of initial clinical presentation and more frequently male (57.9% VCI versus 46.2% non-VCI; p = 0.052). No difference was noted in frequency of vascular risk factors in VCI versus non-VCI cases. Multivariate logistic regression analysis adjusted by age and gender identified overall severity of WMH (tARWMC HR 1.42, 95% CI 1.01-2.00; p0.043) and total number of lacunar infarcts (HR 3.06, 95% CI 1.71-5.50, p < 0.001) as independent predictors of cognitive decline.
In patients with SVD, independent predictors of VCI were baseline severity of WMH and total number of lacunar infarcts.
脑小血管病（SVD）是认知障碍和血管性痴呆的常见病因。
我们旨在研究最初表现为首次腔隙性类型的小皮质下卒中但认知状态正常的SVD患者认知功能下降的预测因素。
共有294例SVD患者在首次就诊后3至5年接受评估。我们分析了基线人口统计学数据、血管危险因素、以改良Rankin量表评分表示的功能状态、腔隙性梗死总数以及磁共振成像上白质高信号（WMH）的严重程度，采用年龄相关白质变化量表总分（tARWMC）以及Fazekas量表的脑室周围和深部皮质下评分。
随访时，188例（63.9%）SVD患者检测出任何类型的血管性认知障碍（VCI），其中65例（22.1%）符合血管性痴呆标准，123例（41.8%）表现为非痴呆性认知障碍。VCI患者在首次临床表现时年龄较大（VCI组为64.4±10.3岁，非VCI组为58.6±10.5岁；p<0.0001），男性比例更高（VCI组为57.9%，非VCI组为46.2%；p=0.052）。VCI组与非VCI组在血管危险因素的频率上未发现差异。经年龄和性别调整的多因素逻辑回归分析确定，WMH的总体严重程度（tARWMC风险比1.42，95%置信区间1.01 - 2.00；p=0.043）和腔隙性梗死总数（风险比3.06，95%置信区间1.71 - 5.50，p<0.001）是认知功能下降的独立预测因素。
在SVD患者中，VCI的独立预测因素是WMH的基线严重程度和腔隙性梗死总数。
