Buchman Aron S, Leurgans Sue E, Nag Sukriti, VanderHorst Veronique G J M, Kapasi Alifiya, Schneider Julie A, Bennett David A
From the Rush Alzheimer's Disease Center (A.S.B., S.E.L., S.N., A.K., J.A.S., D.A.B.), Department of Neurological Sciences (A.S.B., S.E.L., J.A.S., D.A.B.), and Department of Pathology (Neuropathology) (S.N., J.A.S.), Rush University Medical Center, Chicago, IL; Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (V.G.J.M.V.); and Harvard Medical School, Boston, MA (V.G.J.M.V.).
Stroke. 2017 Oct;48(10):2792-2798. doi: 10.1161/STROKEAHA.117.017643. Epub 2017 Sep 20.
There are few studies of spinal microvascular pathologies in older adults. We characterized spinal cord microvascular pathologies and examined their associations with other spinal and brain postmortem indices and parkinsonism in older adults.
We documented 3 features of microvascular pathologies in spinal cord and brain specimens from 165 deceased older participants. We also measured spinal white matter pallor. Parkinsonian signs were assessed with a modified version of the motor section of the Unified Parkinson's Disease Rating Scale. We examined the associations of spinal arteriolosclerosis with other spinal and brain postmortem indices and parkinsonism proximate to death using regression models which controlled for age and sex.
Microinfarcts and cerebral amyloid angiopathy were not observed within the spinal cord parenchyma. Spinal arteriolosclerosis was observed at all spinal levels (C7, T7, L4, S4) examined and was more severe posteriorly than anteriorly (posterior: 4.3, SD=0.72 versus anterior: 3.9, SD=0.74; =14.58; <0.001). Arteriolosclerosis was more severe in the spinal cord than in the brain (cord: 4.10, SD=0.70; brain: 3.5, SD=0.98; =10.39; <0.001). The severity of spinal arteriolosclerosis was associated with spinal white matter pallor (=0.47; <0.001). Spinal arteriolosclerosis accounted for ≈3% of the variation in parkinsonism in models controlling for age, sex, brain arteriolosclerosis, and cerebrovascular disease pathologies. Further models showed that the association of spinal arteriolosclerosis and parkinsonism was not mediated via spinal white matter pallor.
Although the regional distribution of microvascular pathologies varies within the central nervous system, spinal arteriolosclerosis is common and may contribute to the severity of spinal white matter pallor and parkinsonism in older adults.
针对老年人脊髓微血管病变的研究较少。我们对老年人脊髓微血管病变进行了特征描述，并研究了它们与其他脊髓和脑死后指标以及帕金森症之间的关联。
我们记录了165名已故老年参与者的脊髓和脑标本中微血管病变的3个特征。我们还测量了脊髓白质苍白程度。使用统一帕金森病评定量表运动部分的修改版评估帕金森体征。我们使用控制了年龄和性别的回归模型，研究脊髓小动脉硬化与其他脊髓和脑死后指标以及临近死亡时帕金森症之间的关联。
在脊髓实质内未观察到微梗死和脑淀粉样血管病。在所检查的所有脊髓节段（C7、T7、L4、S4）均观察到脊髓小动脉硬化，且后部比前部更严重（后部：4.3，标准差=0.72；前部：3.9，标准差=0.74；t=14.58；P<0.001）。脊髓小动脉硬化比脑内更严重（脊髓：4.10，标准差=0.70；脑：3.5，标准差=0.98；t=10.39；P<0.001）。脊髓小动脉硬化的严重程度与脊髓白质苍白程度相关（r=0.47；P<0.001）。在控制了年龄、性别、脑小动脉硬化和脑血管疾病病变的模型中，脊髓小动脉硬化约占帕金森症变异的3%。进一步的模型显示，脊髓小动脉硬化与帕金森症之间的关联并非通过脊髓白质苍白介导。
尽管微血管病变的区域分布在中枢神经系统内有所不同，但脊髓小动脉硬化很常见，可能导致老年人脊髓白质苍白和帕金森症的严重程度增加。
