Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, South Korea.
Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang Medical Center, Hanyang University College of Medicine, South Korea.
Neuroimage Clin. 2020;25:102140. doi: 10.1016/j.nicl.2019.102140. Epub 2019 Dec 24.
Pulmonary dysfunction is associated with elevated risk of cognitive decline. However, the mechanism underlying this relationship has not been fully investigated. In this study, we investigate the relationships between pulmonary function, cerebral small vessel disease (CSVD) markers, cortical thickness, and the Mini-Mental Status Examination (MMSE) scores in cognitively normal individuals.
We used a cross-sectional study design. We identified 1924 patients who underwent pulmonary function testing, three-dimensional brain magnetic resonance imaging (MRI), and the MMSE. Pulmonary function was analyzed according to the quintiles of percentage predicted values (% pred) for forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV). Regarding CSVD markers, we visually rated white matter hyperintensities (WMH) and manually counted lacunes and microbleeds. Cortical thickness was measured by surface-based methods.
Compared with the highest quintile of FVC, the lowest quintile of FVC (% pred) showed a higher risk of WMH (OR 1.98, 95% CI: 1.21-3.24) and lacunes (OR 1.86, 95% CI: 1.12-3.08). There were no associations between FVC or FEV and cortical thickness. Low FVC, but not FEV, was associated with low MMSE scores. Path analyses showed that WMH partially mediated the positive relationship between FVC (% pred) and MMSE score.
Our findings suggested that decreased pulmonary function was associated with increased CSVD burdens, which in turn wass associated with decreased cognition, even in cognitively normal subjects.
肺功能障碍与认知能力下降的风险增加有关。然而，这种关系的机制尚未得到充分研究。在这项研究中，我们研究了肺功能、脑小血管疾病（CSVD）标志物、皮质厚度与认知正常个体的简易精神状态检查（MMSE）评分之间的关系。
我们采用横断面研究设计。我们确定了 1924 名接受肺功能测试、三维脑磁共振成像（MRI）和 MMSE 检查的患者。根据用力肺活量（FVC）或 1 秒用力呼气量（FEV）的预计百分比（% pred）的五分位数分析肺功能。关于 CSVD 标志物，我们通过视觉评估白质高信号（WMH）并手动计数腔隙和微出血。通过基于表面的方法测量皮质厚度。
与 FVC 的最高五分位相比，FVC 的最低五分位（% pred）显示出更高的 WMH 风险（OR 1.98，95% CI：1.21-3.24）和腔隙（OR 1.86，95% CI：1.12-3.08）。FVC 或 FEV 与皮质厚度之间没有关联。低 FVC，但不是 FEV，与 MMSE 评分低有关。路径分析表明，WMH 部分介导了 FVC（% pred）与 MMSE 评分之间的正相关关系。
我们的研究结果表明，肺功能下降与 CSVD 负担增加有关，而 CSVD 负担增加又与认知能力下降有关，即使在认知正常的受试者中也是如此。
