Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.
Dementia Unit, Neurology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
J Neurol Neurosurg Psychiatry. 2018 Jun;89(6):651-656. doi: 10.1136/jnnp-2017-316724. Epub 2018 Jan 11.
The clinical importance of hippocampal enlarged perivascular spaces (H-EPVS) remains uncertain. We aimed to study their association with vascular risk factors, cognitive function and mild cognitive impairment (MCI).
Data were obtained from the ISSYS (Investigating Silent Strokes in hYpertensives, a magnetic resonance imaging Study) cohort, which is a prospective study of patients with hypertension aged 50-70 with no prior stroke or dementia. Participants were clinically evaluated and underwent a cognitive screening test, Dementia Rating Scale-2, which includes five cognitive subscales (attention, initiation/perseveration, conceptualisation, construction and memory). Besides, they were diagnosed with MCI or normal ageing following standard criteria. H-EPVS were manually counted on brain MRI according to a previous scale and defined as extensive when H-EPVS count was ≥7 (upper quartile). Multivariate models were created to study the relationship between H-EPVS, vascular risk factors and cognitive function.
723 patients were included; the median age was 64 (59-67) and 51% were male. Seventy-two patients (10%) were diagnosed with MCI and 612 (84.6%) had at least 1 H-EPVS. Older age (OR per year=1.04, 95% CI 1.01 to 1.08) and poor blood pressure treatment compliance (OR=1.50, 95% CI 1.07 to 2.11) were independently associated with extensive H-EPVS. Regarding cognitive function, H-EPVS were independently and inversely correlated with verbal reasoning (β=-0.021, 95% CI -0.038 to -0.003). No association was found between H-EPVS and MCI.
H-EPVS are a frequent finding in patients with hypertension and are associated with ageing and poor hypertension treatment compliance. Besides, H-EPVS are associated with worse verbal reasoning function.
海马周围扩大的血管周围间隙（H-EPVS）的临床意义仍不确定。我们旨在研究其与血管危险因素、认知功能和轻度认知障碍（MCI）的关系。
数据来自 ISSYS（调查高血压患者无症状性中风的磁共振成像研究）队列，这是一项针对 50-70 岁无既往中风或痴呆的高血压患者的前瞻性研究。参与者接受了临床评估，并进行了认知筛查测试，即痴呆评定量表-2，该测试包括五个认知子量表（注意力、启动/坚持、概念化、构建和记忆）。此外，根据标准标准，他们被诊断为 MCI 或正常衰老。根据先前的量表，在脑 MRI 上手动计数 H-EPVS，并将 H-EPVS 计数≥7（上四分位数）定义为广泛。建立多变量模型来研究 H-EPVS、血管危险因素和认知功能之间的关系。
共纳入 723 例患者；中位年龄为 64（59-67）岁，51%为男性。72 例（10%）被诊断为 MCI，612 例（84.6%）至少有 1 个 H-EPVS。年龄较大（每年 OR=1.04，95%CI 1.01-1.08）和血压治疗依从性差（OR=1.50，95%CI 1.07-2.11）与广泛的 H-EPVS 独立相关。关于认知功能，H-EPVS 与言语推理呈独立负相关（β=-0.021，95%CI -0.038 至-0.003）。H-EPVS 与 MCI 之间无关联。
H-EPVS 在高血压患者中是一种常见的发现，与年龄增长和较差的高血压治疗依从性有关。此外，H-EPVS 与言语推理功能较差有关。
