Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore.
Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore.
J Alzheimers Dis. 2018;66(2):533-549. doi: 10.3233/JAD-180280.
The association between cerebrovascular disease pathology (measured by white matter hyperintensities, WMH) and brain atrophy in early Alzheimer's disease (AD) remain to be elucidated. Thus, we investigated how WMH influence neurodegeneration and cognition in prodromal and clinical AD. We examined 51 healthy controls, 35 subjects with mild cognitive impairment (MCI), and 30 AD patients. We tested how total and regional WMH is related to specific grey matter volume (GMV) reductions in MCI and AD compared to controls. Stepwise regression analysis was further performed to investigate the association of GMV and regional WMH volume with global cognition. We found that total WMH volume was highest in AD but showed the strongest association with lower GMV in MCI. Frontal and parietal WMH had the most extensive influence on GMV loss in MCI. Additionally, parietal lobe WMH volume (but not hippocampal atrophy) was significantly associated with global cognition in MCI while smaller hippocampal volume (but not WMH volume) was associated with lower global cognition in AD. Thus, although WMH volume was highest in AD subjects, it had a more pervasive influence on brain structure and cognitive impairment in MCI. Our study thus highlights the importance of early detection of cerebrovascular disease, as its intervention at the MCI stage might potentially slow down neurodegeneration.
脑血管疾病病理学（通过脑白质高信号测量）与早期阿尔茨海默病（AD）的脑萎缩之间的关联仍有待阐明。因此，我们研究了脑白质高信号如何影响前驱期和临床 AD 中的神经退行性变和认知。我们检查了 51 名健康对照者、35 名轻度认知障碍（MCI）患者和 30 名 AD 患者。我们测试了与对照组相比，总脑白质高信号和局部脑白质高信号与 MCI 和 AD 特定灰质体积（GMV）减少的关系。进一步进行逐步回归分析，以研究 GMV 和局部脑白质高信号体积与整体认知的相关性。我们发现 AD 患者的总脑白质高信号体积最高，但与 MCI 中 GMV 降低的相关性最强。额叶和顶叶脑白质高信号对 MCI 中 GMV 丢失的影响最广泛。此外，MCI 中顶叶脑白质高信号体积（而不是海马萎缩）与整体认知显著相关，而 AD 中较小的海马体积（而不是脑白质高信号体积）与较低的整体认知相关。因此，尽管 AD 患者的脑白质高信号体积最高，但它对 MCI 中的脑结构和认知障碍有更广泛的影响。因此，我们的研究强调了早期发现脑血管疾病的重要性，因为在 MCI 阶段进行干预可能会减缓神经退行性变。
