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白质高信号与认知障碍和痴呆风险：36项前瞻性研究的系统评价和荟萃分析

White matter hyperintensities and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 36 prospective studies.

作者信息

Hu He-Ying, Ou Ya-Nan, Shen Xue-Ning, Qu Yi, Ma Ya-Hui, Wang Zuo-Teng, Dong Qiang, Tan Lan, Yu Jin-Tai

机构信息

Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.

Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.

出版信息

Neurosci Biobehav Rev. 2021 Jan;120:16-27. doi: 10.1016/j.neubiorev.2020.11.007. Epub 2020 Nov 11.

DOI:10.1016/j.neubiorev.2020.11.007

PMID:33188821

Abstract

BACKGROUND

White matter hyperintensities of presumed vascular origin (WMH) are one of the imaging features of cerebral small vessel disease. Controversies persist about the effects of WMH on cognitive dysfunction. This meta-analysis aimed to identify the associations of WMH with risks of cognitive impairment and dementia.

METHODS

We searched PubMed, EMBASE and Cochrane Library for prospective studies. Primary analyses of cognitive dysfunction and sub-analyses of specific outcomes and study characteristics were conducted using random-effect models.

RESULTS

Thirty-six prospective studies with 19,040 participants were included. WMH at baseline conferred a 14 % elevated risk of cognitive impairment and all-cause dementia (ACD). WMH also conferred 25 % elevated risk of Alzheimer's disease and 73 % elevated risk of vascular dementia. Risk effects of high-grade WMH and continually increasing WMH (in volume or severity) on ACD were revealed. Periventricular WMH conferred a 1.51-fold excess risk for dementia.

CONCLUSIONS

WMH were associated with increased risk of cognitive dysfunction and could become a neuroimaging indicator of dementia.

摘要

背景

假定血管源性的白质高信号（WMH）是脑小血管病的影像学特征之一。关于WMH对认知功能障碍的影响一直存在争议。本荟萃分析旨在确定WMH与认知障碍和痴呆风险之间的关联。

方法

我们检索了PubMed、EMBASE和Cochrane图书馆以查找前瞻性研究。使用随机效应模型对认知功能障碍进行主要分析，并对特定结局和研究特征进行亚分析。

结果

纳入了36项有19040名参与者的前瞻性研究。基线时的WMH使认知障碍和全因痴呆（ACD）的风险升高了14%。WMH还使阿尔茨海默病的风险升高了25%，血管性痴呆的风险升高了73%。揭示了高级别WMH以及持续增加的WMH（体积或严重程度）对ACD的风险效应。脑室周围WMH使痴呆风险增加了1.51倍。