Mosconi Lisa, Walters Michelle, Sterling Joanna, Quinn Crystal, McHugh Pauline, Andrews Randolph E, Matthews Dawn C, Ganzer Christine, Osorio Ricardo S, Isaacson Richard S, De Leon Mony J, Convit Antonio
Department of Neurology, Weill Cornell Medical College, New York City, New York, USA.
Department of Psychiatry, New York University School of Medicine, New York City, New York, USA.
BMJ Open. 2018 Mar 23;8(3):e019362. doi: 10.1136/bmjopen-2017-019362.
To investigate the effects of lifestyle and vascular-related risk factors for Alzheimer's disease (AD) on in vivo MRI-based brain atrophy in asymptomatic young to middle-aged adults.
Cross-sectional, observational.
Broader New York City area. Two research centres affiliated with the Alzheimer's disease Core Center at New York University School of Medicine.
We studied 116 cognitively normal healthy research participants aged 30-60 years, who completed a three-dimensional T1-weighted volumetric MRI and had lifestyle (diet, physical activity and intellectual enrichment), vascular risk (overweight, hypertension, insulin resistance, elevated cholesterol and homocysteine) and cognition (memory, executive function, language) data. Estimates of cortical thickness for entorhinal (EC), posterior cingulate, orbitofrontal, inferior and middle temporal cortex were obtained by use of automated segmentation tools. We applied confirmatory factor analysis and structural equation modelling to evaluate the associations between lifestyle, vascular risk, brain and cognition.
Adherence to a Mediterranean-style diet (MeDi) and insulin sensitivity were both positively associated with MRI-based cortical thickness (diet: β≥0.26, insulin sensitivity β≥0.58, P≤0.008). After accounting for vascular risk, EC in turn explained variance in memory (P≤0.001). None of the other lifestyle and vascular risk variables were associated with brain thickness. In addition, the path associations between intellectual enrichment and better cognition were significant (β≥0.25 P≤0.001), as were those between overweight and lower cognition (β≥-0.22, P≤0.01).
In cognitively normal middle-aged adults, MeDi and insulin sensitivity explained cortical thickness in key brain regions for AD, and EC thickness predicted memory performance in turn. Intellectual activity and overweight were associated with cognitive performance through different pathways. Our findings support further investigation of lifestyle and vascular risk factor modification against brain ageing and AD. More studies with larger samples are needed to replicate these research findings in more diverse, community-based settings.
研究生活方式和阿尔茨海默病（AD）的血管相关危险因素对无症状中青年成人基于磁共振成像（MRI）的脑萎缩的影响。
横断面观察性研究。
纽约市更广泛地区。隶属于纽约大学医学院阿尔茨海默病核心中心的两个研究中心。
我们研究了116名年龄在30 - 60岁、认知正常的健康研究参与者，他们完成了三维T1加权容积MRI检查，并拥有生活方式（饮食、体育活动和智力充实度）、血管风险（超重、高血压、胰岛素抵抗、胆固醇和同型半胱氨酸升高）以及认知（记忆、执行功能、语言）数据。通过使用自动分割工具获得内嗅皮质（EC）、后扣带回、眶额皮质、颞中下回皮质的皮质厚度估计值。我们应用验证性因子分析和结构方程模型来评估生活方式、血管风险、大脑和认知之间的关联。
坚持地中海式饮食（MeDi）和胰岛素敏感性均与基于MRI的皮质厚度呈正相关（饮食：β≥0.26，胰岛素敏感性β≥0.58，P≤0.008）。在考虑血管风险后，EC依次解释了记忆方面的方差（P≤0.001）。其他生活方式和血管风险变量均与脑厚度无关。此外，智力充实度与更好的认知之间的路径关联显著（β≥0.25，P≤0.001），超重与较低认知之间的路径关联也显著（β≥ - 0.22，P≤0.01）。
在认知正常的中年成年人中，MeDi和胰岛素敏感性解释了AD关键脑区的皮质厚度，而EC厚度依次预测了记忆表现。智力活动和超重通过不同途径与认知表现相关。我们的研究结果支持进一步研究针对脑老化和AD的生活方式及血管危险因素的调整。需要更多样本量更大的研究在更多样化的社区环境中重复这些研究结果。
