van Uden Ingeborg W M, van der Holst Helena M, Tuladhar Anil M, van Norden Anouk G W, de Laat Karlijn F, Rutten-Jacobs Loes C A, Norris David G, Claassen Jurgen A H R, van Dijk Ewoud J, Kessels Roy P C, de Leeuw Frank-Erik
Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands.
Department of Neurology, Amphia ziekenhuis Breda, The Netherlands.
J Alzheimers Dis. 2016;49(3):863-73. doi: 10.3233/JAD-150573.
The relationship between cerebral small vessel disease (SVD) and dementia has been studied without considering white matter (WM) volume, the microstructural integrity of the WM surrounding the SVD, and grey matter (GM).
We prospectively investigated the relationship between these structures and the risk of dementia, and formed a prediction model to investigate which characteristics (macro- or microstructural) explained most of the variance.
The RUN DMC study is a prospective cohort study among 503 non-demented participants with an age between 50 and 85 years at baseline, with baseline assessment in 2006 and follow-up assessment in 2012. Two were lost to follow-up (yielding a 99.6% response-rate). Cox regression analysis was used, to calculate hazard ratios for dementia, of baseline MRI characteristics. Tract-Based Spatial Statistics (TBSS) analysis was used to assess the added value of microstructural integrity of the WM.
Mean age at baseline was 65.6 years (SD 8.8) and 56.8% was male. 43 participants developed dementia (8.6%), resulting in a 5.5-year cumulative risk of 11.1% (95% CI 7.7-14.6). Low WM and hippocampal volume are significant predictors for dementia. WM, WM hyperintensities, and hippocampal volume explained most of the variance. TBSS analyses showed no additional value of diffusion parameters.
WM and hippocampal volume were the main predictors for the development of incident dementia at 5-year follow-up in elderly with SVD. There was no additional diagnostic value of the diffusion tensor imaging parameters on top of the macrostructural characteristics.
在研究脑小血管疾病（SVD）与痴呆症之间的关系时，未考虑白质（WM）体积、SVD周围WM的微观结构完整性以及灰质（GM）。
我们前瞻性地研究了这些结构与痴呆症风险之间的关系，并构建了一个预测模型，以探究哪些特征（宏观或微观结构）能解释大部分变异。
RUN DMC研究是一项前瞻性队列研究，纳入了503名基线时年龄在50至85岁之间的非痴呆参与者，于2006年进行基线评估，并于2012年进行随访评估。两名参与者失访（应答率为99.6%）。采用Cox回归分析来计算基线MRI特征的痴呆症风险比。基于纤维束的空间统计学（TBSS）分析用于评估WM微观结构完整性的附加价值。
基线时的平均年龄为65.6岁（标准差8.8），男性占56.8%。43名参与者患上痴呆症（8.6%），5.5年的累积风险为11.1%（95%可信区间7.7 - 14.6）。低WM和海马体积是痴呆症的显著预测因素。WM、WM高信号和海马体积解释了大部分变异。TBSS分析显示扩散参数无附加价值。
在患有SVD的老年人中，5年随访时WM和海马体积是新发痴呆症发生的主要预测因素。除宏观结构特征外，扩散张量成像参数没有额外的诊断价值。
