Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
J Alzheimers Dis. 2018;63(2):515-527. doi: 10.3233/JAD-170573.
White matter hyperintensities (WMHs) are related to cognitive dysfunction in the general population. The clinical relevance of WMHs in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) is, however, unclear.
This meta-analysis aimed to quantify the association of WMHs and specific cognitive domains in patients with MCI or AD.
PubMed (January 1990-January 2017) was searched for studies that used MRI to quantify WMHs, and measured cognitive functioning (≥1 predefined cognitive domain with ≥1 test) in a well-defined population of persons diagnosed with MCI or AD. Fischer's Z was used as the common metric for effect size. Modifying effects of demographics, MMSE, and WMH location were examined.
Twelve cross-sectional studies on AD (total n = 1,370, median age 75 years) and 10 studies on MCI (9 cross-sectional, 1 longitudinal; total n = 2,286, median age 73 years) were included. The association between WMHs and overall cognition was significantly stronger for MCI (-0.25, -0.36 to -0.14) than for AD (-0.11, -0.14 to -0.08; QM = 10.7, p < 0.05). For both groups, largest effect sizes were found in attention and executive functions (-0.26, -0.36 to -0.15) and processing speed (-0.21, -0.35 to -0.12). No significant modifying effects of age and gender were found.
WMHs have a medium-sized association with different cognitive functions in patients with MCI and a small, but statistically significant, association with cognition in AD. These result underscore the role of co-occurring vascular brain damage in MCI and AD.
脑白质高信号（WMHs）与一般人群的认知功能障碍有关。然而，阿尔茨海默病（AD）和轻度认知障碍（MCI）患者的 WMH 的临床相关性尚不清楚。
本荟萃分析旨在量化 MCI 或 AD 患者的 WMH 与特定认知域的相关性。
通过检索 PubMed（1990 年 1 月至 2017 年 1 月），查找使用 MRI 定量 WMHs 并在明确诊断为 MCI 或 AD 的人群中测量认知功能（至少 1 个有≥1 个测试的预先定义认知域）的研究。Fisher's Z 被用作效应量的通用度量。检查了人口统计学、MMSE 和 WMH 位置的调节作用。
纳入了 12 项关于 AD（共 n = 1,370，中位年龄 75 岁）的横断面研究和 10 项关于 MCI（9 项横断面，1 项纵向；共 n = 2,286，中位年龄 73 岁）的研究。WMHs 与 MCI 患者整体认知的相关性明显强于 AD 患者（-0.25，-0.36 至-0.14）（QM = 10.7，p < 0.05）。对于这两个组，最大的效应量出现在注意力和执行功能（-0.26，-0.36 至-0.15）和处理速度（-0.21，-0.35 至-0.12）。未发现年龄和性别有显著的调节作用。
WMHs 与 MCI 患者的不同认知功能具有中等相关性，与 AD 患者的认知功能具有较小但具有统计学意义的相关性。这些结果强调了血管性脑损伤在 MCI 和 AD 中的共同作用。
