Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.
Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.
Stroke. 2020 Nov;51(11):3271-3278. doi: 10.1161/STROKEAHA.120.030446. Epub 2020 Oct 6.
We aim to describe the burden, characteristics, and cognitive associations of cerebral small vessel disease in a Canadian sample living with multimorbidity in precarious housing.
Participants received T1, T2-fluid-attenuated inversion recovery, and susceptibility-weighted imaging 3T magnetic resonance imaging sequences and comprehensive clinical, laboratory, and cognitive assessments. Cerebral small vessel disease burden was characterized using a modified Small Vessel Disease (mSVD) score. One point each was given for moderate-severe white matter hyperintensities, ≥1 cerebral microbleeds, and ≥1 lacune. Multivariable regression explored associations between mSVD score, risk factors, and cognitive performance.
Median age of the 228 participants (77% male) was 44.7 years (range, 23.3-63.2). In n=188 participants with consistent good quality magnetic resonance imaging sequences, mSVD scores were 0 (n=127, 68%), 1 (n=50, 27%), and 2 (n=11, 6%). Overall, one-third had an mSVD ≥1 n=61 (32%); this proportion was unchanged when adding participants with missing sequences n=72/228 (32%). The most prevalent feature was white matter hyperintensities 53/218 (24%) then cerebral microbleed 16/191 (8%) and lacunes 16/228 (7%). Older age (odds ratio, 1.10 [95% CI, 1.05-1.15], <0.001), higher diastolic blood pressure (odds ratio, 1.05 [95% CI, 1.01-1.09], =0.008), and a history of injection drug use (odds ratio, 3.13 [95% CI, 1.07-9.16], =0.037) had significant independent associations with a mSVD score of ≥1 in multivariable analysis. mSVD ≥1 was associated with lower performance on tests of verbal memory, sustained attention, and decision-making, contributing 4% to 5% of the variance in each cognitive domain.
The 32% prevalence of cerebral small vessel disease in this young, socially marginalized cohort was higher than expected for age and was associated with poorer cognitive performance.
本研究旨在描述在加拿大一个居住在不稳定住房中患有多种疾病的人群中，脑小血管疾病的负担、特征以及与认知的关联。
参与者接受了 T1、T2 液体衰减反转恢复和磁敏感加权成像 3T 磁共振成像序列以及全面的临床、实验室和认知评估。采用改良的小血管疾病（mSVD）评分来描述脑小血管疾病负担。中度至重度脑白质高信号、≥1 个脑微出血和≥1 个腔隙各记 1 分。多变量回归分析了 mSVD 评分、危险因素与认知表现之间的关系。
228 名参与者（77%为男性）的中位年龄为 44.7 岁（范围 23.3-63.2）。在 n=188 名具有一致高质量磁共振成像序列的参与者中，mSVD 评分为 0（n=127，68%）、1（n=50，27%）和 2（n=11，6%）。总体而言，三分之一的参与者的 mSVD≥1（n=61，32%）；当纳入缺失序列的 n=72/228（32%）参与者时，这一比例保持不变。最常见的特征是脑白质高信号（53/218，24%），其次是脑微出血（16/191，8%）和腔隙（16/228，7%）。年龄较大（优势比，1.10[95%可信区间，1.05-1.15]，<0.001）、较高的舒张压（优势比，1.05[95%可信区间，1.01-1.09]，=0.008）和使用注射药物的既往史（优势比，3.13[95%可信区间，1.07-9.16]，=0.037）与多变量分析中 mSVD 评分≥1 有显著的独立关联。mSVD≥1 与言语记忆、持续注意力和决策等认知测试的表现较差相关，导致每个认知领域的变异贡献了 4%至 5%。
在这个年轻、社会边缘化的队列中，脑小血管疾病的 32%患病率高于预期年龄，且与认知表现较差有关。
