Romero José R, Beiser Alexa, Himali Jayandra J, Shoamanesh Ashkan, DeCarli Charles, Seshadri Sudha
Department of Neurology, School of Public Health at Boston University, Boston, MA, USA; NHLBI's Framingham Heart Study, Framingham, MA, USA.
Department of Neurology, School of Public Health at Boston University, Boston, MA, USA; NHLBI's Framingham Heart Study, Framingham, MA, USA; Department of Biostatistics, School of Public Health at Boston University, Boston, MA, USA.
Neurobiol Aging. 2017 Jun;54:94-99. doi: 10.1016/j.neurobiolaging.2017.02.018. Epub 2017 Mar 6.
Cerebral microbleeds (CMBs) are MRI markers attributed to the most common cerebral angiopathies in the elderly and in patients with dementia: hypertensive and cerebral amyloid angiopathy. CMB detection in asymptomatic persons may help identify those at risk for dementia and may influence preventive strategies and design of clinical trials testing treatments for dementia. We studied the association of CMB with risk of incident dementia in community dwelling individuals. A total of 1296 dementia-free Framingham Heart Study participants (mean age 72 years; 54% women) with available brain MRI and incident dementia data during a mean follow-up period of 6.7 years were included. Using Cox proportional hazards models, we related CMB presence to incident dementia. Multivariable models were adjusted for age, sex, APOE status, and education, with additional models adjusting for vascular risk factors and MRI markers of ischemic brain injury. CMBs were observed in 10.8% and incident dementia in 85 participants (6.6% over study period). Participants with any CMB had 1.74 times higher risk of dementia (hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.00-3.01), whereas those with deep and mixed CMB had a three-fold increased risk (HR 2.99, 95% CI 1.52-5.90). The associations were independent of vascular risk factors, and for deep and mixed CMB also independent of MRI markers of ischemia (HR 2.44, 95% CI 1.22-4.88). Purely lobar CMBs were not associated with incident dementia. Our findings support a role for hypertensive vasculopathy and the interplay of hypertensive and cerebral amyloid angiopathy in risk of dementia and suggest that CMB presence can identify individuals at risk of dementia.
脑微出血（CMBs）是MRI标记物，与老年人及痴呆患者中最常见的脑血管病变有关：高血压性脑小血管病和脑淀粉样血管病。在无症状人群中检测CMBs可能有助于识别痴呆风险人群，并可能影响预防策略以及痴呆治疗临床试验的设计。我们研究了社区居住个体中CMBs与新发痴呆风险之间的关联。纳入了1296名无痴呆的弗雷明汉心脏研究参与者（平均年龄72岁；54%为女性），这些参与者有可用的脑部MRI数据以及平均随访6.7年期间的新发痴呆数据。使用Cox比例风险模型，我们将CMBs的存在情况与新发痴呆相关联。多变量模型对年龄、性别、APOE状态和教育程度进行了调整，另外的模型还对血管危险因素和缺血性脑损伤的MRI标记物进行了调整。观察到10.8%的参与者有CMBs，85名参与者（研究期间为6.6%）出现新发痴呆。有任何CMBs的参与者患痴呆的风险高1.74倍（风险比[HR] 1.74，95%置信区间[CI] 1.00 - 3.01），而有深部和混合性CMBs的参与者患痴呆的风险增加了两倍（HR 2.99，95% CI 1.52 - 5.90）。这些关联独立于血管危险因素，对于深部和混合性CMBs，也独立于缺血的MRI标记物（HR 2.44，95% CI 1.22 - 4.88）。单纯的脑叶CMBs与新发痴呆无关。我们的研究结果支持高血压性血管病变以及高血压与脑淀粉样血管病的相互作用在痴呆风险中的作用，并表明CMBs的存在可识别痴呆风险个体。
