可能由脑淀粉样血管病导致的脑出血后迟发性痴呆的预测因子。
Predictors for Late Post-Intracerebral Hemorrhage Dementia in Patients with Probable Cerebral Amyloid Angiopathy.
机构信息
Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.
Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France.
出版信息
J Alzheimers Dis. 2019;71(2):435-442. doi: 10.3233/JAD-190346.
BACKGROUND AND OBJECTIVE
Cerebral amyloid angiopathy (CAA) accounts for the majority of lobar intracerebral hemorrhage (ICH); however, the risk factors for dementia conversion after ICH occurrence in CAA patients are unknown, especially in the long-term period after ICH. Therefore, we aimed to unravel the predictors for late post-ICH dementia (6 months after ICH event) in probable CAA patients.
METHODS
From a large consecutive MRI prospective cohort of spontaneous ICH (2006-2017), we identified probable CAA patients (modified Boston criteria) without dementia 6 months post-ICH. Cognitive outcome during follow-up was determined based on the information from standardized clinical visit notes. We used Cox regression analysis to investigate the association between baseline demographic characteristics, past medical history, MRI biomarkers, and late post-ICH dementia conversion (dementia occurred after 6 months).
RESULTS
Among 97 non-demented lobar ICH patients with probable CAA, 25 patients (25.8%) developed dementia during a median follow-up time of 2.5 years (IQR 1.5-3.8 years). Pre-existing mild cognitive impairment, increased white matter hyperintensities (WMH) burden, the presence of disseminated cortical superficial siderosis (cSS), and higher total small vessel disease score for CAA were all independent predictors for late dementia conversion.
CONCLUSION
In probable CAA patients presenting with lobar ICH, high WMH burden and presence of disseminated cSS are useful neuroimaging biomarkers for dementia risk stratification. These findings have implications for clinical practice and future trial design.
背景与目的
脑淀粉样血管病（Cerebral amyloid angiopathy，CAA）占脑叶脑出血（Intracerebral hemorrhage，ICH）的大部分；然而，CAA 患者发生 ICH 后发生痴呆的危险因素尚不清楚，尤其是在 ICH 发生后的长期。因此，我们旨在探讨可能的 CAA 患者发生 ICH 后迟发性 post-ICH 痴呆（ICH 发生后 6 个月）的预测因素。
方法
从 2006 年至 2017 年一项大型连续 MRI 前瞻性自发性 ICH 队列中，我们确定了可能的 CAA 患者（改良波士顿标准）在 ICH 后 6 个月无痴呆。根据标准化临床就诊记录中的信息确定随访期间的认知结果。我们使用 Cox 回归分析来探讨基线人口统计学特征、既往病史、MRI 生物标志物与迟发性 post-ICH 痴呆转化（痴呆发生在 6 个月后）之间的关联。
结果
在 97 例非痴呆性脑叶 ICH 合并可能的 CAA 患者中，25 例（25.8%）在中位随访时间 2.5 年（IQR 1.5-3.8 年）期间发生痴呆。预先存在的轻度认知障碍、脑白质高信号（White matter hyperintensities，WMH）负担增加、弥漫性皮质浅表铁沉积（Disseminated cortical superficial siderosis，cSS）的存在和 CAA 的总小血管疾病评分较高均为迟发性痴呆转化的独立预测因素。
结论
在表现为脑叶 ICH 的可能的 CAA 患者中，WMH 负担高和弥漫性 cSS 的存在是痴呆风险分层的有用神经影像学生物标志物。这些发现对临床实践和未来的试验设计具有重要意义。
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