Neurology Department and Stroke Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy.
Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
PLoS One. 2019 Apr 24;14(4):e0216162. doi: 10.1371/journal.pone.0216162. eCollection 2019.
Although cerebral white matter lesions (WMLs) are considered as a risk factor for vascular dementia, data on their impact on cerebral hemodynamics are scarce. We test and compare transcranial Doppler (TCD) features in WML patients with or without associated cognitive impairment.
A sample of non-demented elderly patients with WMLs was consecutively recruited. Mean blood flow velocity (MBFV), pulsatility index (PI), peak systolic blood flow velocity (PSV), end-diastolic blood flow velocity (EDV), and resistivity index (RI) were recorded from the middle cerebral artery bilaterally. Global cognitive functioning, frontal lobe abilities, functional status, and WML severity were also assessed.
161 patients satisfying the clinical criteria for vascular cognitive impairment-no dementia (VCI-ND) were age-matched with 97 presenting WMLs without any cognitive deficit. VCI-ND patients exhibited a decrease in MBFV and EDV, as well as an increase in PI, RI, and PSV. Moreover, a significant correlation between all TCD parameters and the severity of executive dysfunction was observed, whereas PI, RI, and EDV were significantly correlated with the WML load.
VCI-ND showed a hemodynamic pattern indicative of cerebral hypoperfusion and enhanced vascular resistance. These changes may be considered as the TCD correlate of VCI-ND due to microcirculation pathology. TCD provides useful indices of the occurrence and severity of small vessel disease and executive dysfunction in elderly patients at risk of future dementia.
尽管脑白质病变（WML）被认为是血管性痴呆的一个危险因素，但关于其对脑血流动力学影响的数据却很少。我们测试并比较了有或无认知障碍的 WML 患者的经颅多普勒（TCD）特征。
连续招募了一组无痴呆的老年 WML 患者。从双侧大脑中动脉记录平均血流速度（MBFV）、搏动指数（PI）、收缩期血流速度峰值（PSV）、舒张末期血流速度（EDV）和阻力指数（RI）。还评估了整体认知功能、额叶能力、功能状态和 WML 严重程度。
符合血管性认知障碍-非痴呆（VCI-ND）临床标准的 161 例患者与 97 例无任何认知缺陷的 WML 患者年龄匹配。VCI-ND 患者的 MBFV 和 EDV 降低，PI、RI 和 PSV 增加。此外，所有 TCD 参数与执行功能障碍严重程度之间存在显著相关性，而 PI、RI 和 EDV 与 WML 负荷显著相关。
VCI-ND 表现出脑灌注不足和血管阻力增强的血流动力学模式。这些变化可能被认为是由于微循环病理学导致 VCI-ND 的 TCD 相关因素。TCD 为老年患者未来痴呆风险的小血管疾病和执行功能障碍的发生和严重程度提供了有用的指标。
