Zamboni Giovanna, Griffanti Ludovica, Jenkinson Mark, Mazzucco Sara, Li Linxin, Küker Wilhelm, Pendlebury Sarah T, Rothwell Peter M
From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital (G.Z., L.G., S.M., L.L., W.K., S.T.P., P.M.R.) and Oxford Centre for Functional MRI of the Brain (FMRIB) (M.J.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom.
Stroke. 2017 Jun;48(6):1539-1547. doi: 10.1161/STROKEAHA.116.016044. Epub 2017 May 9.
Among screening tools for cognitive impairment in large cohorts, the Montreal Cognitive Assessment (MoCA) seems to be more sensitive to early cognitive impairment than the Mini-Mental State Examination (MMSE), particularly after transient ischemic attack or minor stroke. We reasoned that if MoCA-detected early cognitive impairment is pathologically significant, then it should be specifically associated with the presence of white matter hyperintensities (WMHs) and reduced fractional anisotropy (FA) on magnetic resonance imaging.
Consecutive eligible patients with transient ischemic attack or minor stroke (Oxford Vascular Study) underwent magnetic resonance imaging and cognitive assessment. We correlated MoCA and MMSE scores with WMH and FA, then specifically studied patients with low MoCA and normal MMSE.
Among 400 patients, MoCA and MMSE scores were significantly correlated (all <0.001) with WMH volumes (=-0.336; =-0.297) and FA (=0.409; =0.369) and-on voxel-wise analyses-with WMH in frontal white matter and reduced FA in almost all white matter tracts. However, only the MoCA was independently correlated with WMH volumes (=-0.183; <0.001), average FA values (=0.218; <0.001), and voxel-wise reduced FA in anterior tracts after controlling for the MMSE. In addition, patients with low MoCA but normal MMSE (n=57) had higher WMH volumes (=3.1; =0.002), lower average FA (=-4.0; <0.001), and lower voxel-wise FA in almost all white matter tracts than those with normal MoCA and MMSE (n=238).
In patients with transient ischemic attack or minor stroke, early cognitive impairment detected with the MoCA but not with the MMSE was independently associated with white matter damage on magnetic resonance imaging, particularly reduced FA.
在大型队列中用于认知障碍筛查的工具中，蒙特利尔认知评估量表（MoCA）似乎比简易精神状态检查表（MMSE）对早期认知障碍更敏感，尤其是在短暂性脑缺血发作或轻度卒中之后。我们推断，如果MoCA检测到的早期认知障碍具有病理学意义，那么它应该与磁共振成像上白质高信号（WMH）的存在以及分数各向异性（FA）降低有特异性关联。
连续纳入符合条件的短暂性脑缺血发作或轻度卒中患者（牛津血管研究），进行磁共振成像和认知评估。我们将MoCA和MMSE评分与WMH和FA进行关联，然后专门研究MoCA低但MMSE正常的患者。
在400例患者中，MoCA和MMSE评分与WMH体积（r=-0.336；r=-0.297）和FA（r=0.409；r=0.369）显著相关（均P<0.001），并且在体素分析中，与额叶白质中的WMH以及几乎所有白质束中的FA降低相关。然而，在控制MMSE后，只有MoCA与WMH体积（r=-0.183；P<0.001）、平均FA值（r=0.218；P<0.001）以及前束中体素水平的FA降低独立相关。此外，MoCA低但MMSE正常的患者（n=57）比MoCA和MMSE正常的患者（n=238）具有更高的WMH体积（P=3.1；P=0.002）、更低的平均FA（P=-4.0；P<0.001）以及几乎所有白质束中更低的体素水平FA。
在短暂性脑缺血发作或轻度卒中患者中，通过MoCA而非MMSE检测到的早期认知障碍与磁共振成像上的白质损伤独立相关，尤其是FA降低。
