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脑卒后执行功能障碍的微观结构退变与脑血管风险负担。

Microstructural degeneration and cerebrovascular risk burden underlying executive dysfunction after stroke.

机构信息

Department of Experimental Psychology, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.

The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.

出版信息

Sci Rep. 2020 Oct 21;10(1):17911. doi: 10.1038/s41598-020-75074-w.

Abstract

Executive dysfunction affects 40% of stroke patients, but is poorly predicted by characteristics of the stroke itself. Stroke typically occurs on a background of cerebrovascular burden, which impacts cognition and brain network structural integrity. We used structural equation modelling to investigate whether measures of white matter microstructural integrity (fractional anisotropy and mean diffusivity) and cerebrovascular risk factors better explain executive dysfunction than markers of stroke severity. 126 stroke patients (mean age 68.4 years) were scanned three months post-stroke and compared to 40 age- and sex-matched control participants on neuropsychological measures of executive function. Executive function was below what would be expected for age and education level in stroke patients as measured by the organizational components of the Rey Complex Figure Test, F(3,155) = 17, R = 0.25, p < 0.001 (group significant predictor at p < 0.001) and the Trail-Making Test (B), F(3,157) = 3.70, R = 0.07, p < 0.01 (group significant predictor at p < 0.001). A multivariate structural equation model illustrated the complex relationship between executive function, white matter integrity, stroke characteristics and cerebrovascular risk (root mean square error of approximation = 0.02). Pearson's correlations confirmed a stronger relationship between executive dysfunction and white matter integrity (r = - 0.74, p < 0.001), than executive dysfunction and stroke severity (r = 0.22, p < 0.01). The relationship between executive function and white matter integrity is mediated by cerebrovascular burden. White matter microstructural degeneration of the superior longitudinal fasciculus in the executive control network better explains executive dysfunction than markers of stroke severity. Executive dysfunction and incident stroke can be both considered manifestations of cerebrovascular risk factors.

摘要

执行功能障碍影响 40%的中风患者,但自身的中风特征很难预测。中风通常发生在脑血管负担的背景下,这会影响认知和大脑网络结构的完整性。我们使用结构方程模型来研究脑白质微观结构完整性(各向异性分数和平均扩散率)和脑血管危险因素是否比中风严重程度的标志物更好地解释执行功能障碍。126 名中风患者(平均年龄 68.4 岁)在中风后三个月接受扫描,并与 40 名年龄和性别匹配的对照参与者进行神经心理学执行功能测试。执行功能低于中风患者根据 Rey 复杂图形测试的组织成分预期的年龄和教育水平,F(3,155)=17,R=0.25,p<0.001(组显著预测因子 p<0.001)和 Trail-Making Test(B),F(3,157)=3.70,R=0.07,p<0.01(组显著预测因子 p<0.001)。多元结构方程模型说明了执行功能、脑白质完整性、中风特征和脑血管风险之间的复杂关系(均方根误差逼近值=0.02)。皮尔逊相关性证实,执行功能障碍与脑白质完整性之间的关系更强(r=-0.74,p<0.001),而不是与中风严重程度之间的关系(r=0.22,p<0.01)。执行功能与脑白质完整性之间的关系受脑血管负担的影响。执行控制网络中的上纵束的脑白质微观结构退化比中风严重程度标志物更好地解释执行功能障碍。执行功能障碍和中风事件都可以被认为是脑血管危险因素的表现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b96/7578057/4a8bb6fbdb45/41598_2020_75074_Fig1_HTML.jpg

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