Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Can J Neurol Sci. 2019 Jul;46(4):383-388. doi: 10.1017/cjn.2019.47. Epub 2019 May 28.
White matter hyperintensities (WMHs) were commonly seen in brain magnetic resonance imaging (MRI) of the elderly. Many studies found that WMHs were associated with cognitive decline and dementia. However, the association between WMHs in different brain regions and cognitive decline remains debated.
We explored the association of the severity of WMHs and cognitive decline in 115 non-demented elderly (≥50 years old) sampled from the Wuliqiao Community located in urban area of Shanghai. MRI scans were done during 2009-2011 at the beginning of the study. Severity of WMHs in different brain regions was scored by Improved Scheltens Scale and Cholinergic Pathways Hyperintensities Scale (CHIPS). Cognitive function was evaluated by Mini-Mental State Examination (MMSE) every 2 to 4 years during 2009-2018.
After adjusting for confounding factors including age, gender, education level, smoking status, alcohol consumption, depression, hypertension, diabetes, hyperlipidemia, brain infarcts, brain atrophy, apoE4 status, and baseline MMSE score, periventricular and subcortical WMH lesions as well as WMHs in cholinergic pathways were significantly associated with annual MMSE decline ( p < 0.05), in which the severity of periventricular WMHs predicted a faster MMSE decline (-0.187 points/year, 95% confidence interval: -0.349, -0.026, p = 0.024).
The severity of WMHs at baseline was associated with cognitive decline in the non-demented elderly over time. Interventions on WMH lesions may offer some benefits for cognitive deterioration.
老年人的脑部磁共振成像（MRI）通常可见到脑白质高信号（WMHs）。许多研究发现，WMHs 与认知能力下降和痴呆有关。然而，不同脑区 WMH 与认知能力下降之间的关联仍存在争议。
我们对来自上海市城区五里桥社区的 115 名非痴呆老年人（≥50 岁）的 WMH 严重程度与认知能力下降之间的关系进行了研究。MRI 扫描于 2009-2011 年在研究开始时进行。不同脑区 WMH 的严重程度采用改良 Scheltens 量表和胆碱能通路高信号量表（CHIPS）进行评分。认知功能采用简易精神状态检查（MMSE）在 2009-2018 年期间每 2 至 4 年评估一次。
在校正年龄、性别、教育程度、吸烟状况、饮酒状况、抑郁、高血压、糖尿病、高血脂、脑梗死、脑萎缩、载脂蛋白 E4 状态和基线 MMSE 评分等混杂因素后，脑室周围和皮质下 WMH 病变以及胆碱能通路中的 WMH 与 MMSE 每年的下降显著相关（p < 0.05），其中脑室周围 WMH 的严重程度预示着 MMSE 下降更快（-0.187 分/年，95%置信区间：-0.349，-0.026，p = 0.024）。
基线时 WMH 的严重程度与非痴呆老年人随时间推移的认知能力下降有关。WMH 病变的干预可能为认知恶化带来一些益处。
