白质高信号可预测社区老年人发生认知衰退的风险。
White Matter Hyperintensity Predicts the Risk of Incident Cognitive Decline in Community Dwelling Elderly.
作者信息
Ding Ding, Xiong Yunyun, Zhao Qianhua, Guo Qihao, Chu Shuguang, Chu Winnie W C, Luo Jianfeng, Liang Xiaoniu, Zheng Li, Hong Zhen, Wong Lawrence K S, Mok Vincent C T
机构信息
Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China.
National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
出版信息
J Alzheimers Dis. 2018;61(4):1333-1341. doi: 10.3233/JAD-170876.
BACKGROUND
Unlike western countries, data on white matter hyperintensity (WMH) in community dwelling elderly in Asian population is very limited.
OBJECTIVE
To examine the relation between baseline WMH burden and the risk of incident cognitive decline in a community-based cohort with Chinese-dwelling elderly.
METHODS
We prospectively evaluated the incident cognitive decline for 226 participants in the Shanghai Aging Study. Baseline WMH severity was visually rated by the age-related white matter changes (ARWMC) scale based on MRI. Cox proportional hazards regression model was used to estimate the relative risk (RR) of total ARWMC scale, global ARWMC score, presence of lacune and microbleed, for incident cognitive decline by adjusting potential confounders.
RESULTS
Forty subjects were identified with incident cognitive decline (new onset 34 mild cognitive impairment and 6 dementia) during a median duration of 6 years follow-up. The incidence of cognitive decline was 3.0 (95% confidence interval [CI] 2.2-4.1) per 100 person-years. Increasing total ARWMC scale [RR1.21 (95% CI 1.06-1.39), p = 0.004)], confluent WMH [RR3.16 (95% CI 1.50-6.64), p = 0.002), and presence of lacunes [RR 2.73 (95% CI 1.21-6.15)] at baseline were independent predictors of incident cognitive decline.
CONCLUSION
Our study demonstrated that confluent WMH may increase the risk of incident cognitive decline by 3 folds in community dwelling subjects. Small vessel disease may cause heavy burden of cognitive impairment in the elderly in China.
背景
与西方国家不同，亚洲社区居住老年人的白质高信号（WMH）数据非常有限。
目的
在一个以华裔居住老年人为基础的队列中，研究基线WMH负担与认知功能下降风险之间的关系。
方法
我们对上海老龄化研究中的226名参与者进行了前瞻性认知功能下降评估。基于MRI，采用年龄相关白质改变（ARWMC）量表对基线WMH严重程度进行视觉评分。使用Cox比例风险回归模型，通过调整潜在混杂因素来估计总ARWMC量表、全球ARWMC评分、腔隙和微出血的存在对认知功能下降的相对风险（RR）。
结果
在中位随访6年期间，40名受试者被确定为发生认知功能下降（新发34例轻度认知障碍和6例痴呆）。认知功能下降的发生率为每100人年3.0（95%置信区间[CI]2.2 - 4.1）。基线时总ARWMC量表增加[RR 1.21（95% CI 1.06 - 1.39），p = 0.004]、融合性WMH[RR 3.16（95% CI 1.50 - 6.64），p = 0.002]和腔隙的存在[RR 2.73（95% CI 1.21 - 6.15）]是认知功能下降的独立预测因素。
结论
我们的研究表明，在社区居住人群中，融合性WMH可能使认知功能下降风险增加3倍。小血管疾病可能给中国老年人带来沉重的认知障碍负担。
Zotero 插件