Kang Sung Hoon, Kim Monica Eunseo, Jang Hyemin, Kwon Hojeong, Lee Hyejoo, Kim Hee Jin, Seo Sang Won, Na Duk L
From the Department of Neurology, Sungkyunkwan University School of Medicine (S.H.K., H.J., H.L., H.J.K., S.W.S., D.L.N.), Neuroscience Center (S.H.K., H.J., H.L., H.J.K., S.W.S., D.L.N.), and Stem Cell & Regenerative Medicine Institute (D.L.N.), Samsung Medical Center; Department of Neurology (S.H.K.), Korea University Guro Hospital, Korea University College of Medicine, Seoul; Chicago College of Osteopathic Medicine (M.E.K.), Midwestern University, IL; New York University (H.K.), NY; and Department of Health Sciences and Technology, SAIHST (D.L.N.), Sungkyunkwan University, Seoul, Korea.
Neurology. 2021 Apr 27;96(17):e2201-e2211. doi: 10.1212/WNL.0000000000011833. Epub 2021 Mar 15.
We investigated the frequency of β-amyloid (Aβ) positivity in 9 groups classified according to a combination of 3 different cognition states and 3 distinct levels of white matter hyperintensities (WMH) (minimal, moderate, and severe) and aimed to determine which factors were associated with Aβ after controlling for WMH and vice versa.
A total of 1,047 individuals with subjective cognitive decline (SCD, n = 294), mild cognitive impairment (MCI, n = 237), or dementia (n = 516) who underwent Aβ PET scans were recruited from the memory clinic at Samsung Medical Center in Seoul, Korea. We investigated the following: (1) Aβ positivity in the 9 groups, (2) the relationship between Aβ positivity and WMH severity, and (3) clinical and genetic factors independently associated with Aβ or WMH.
Aβ positivity increased as the severity of cognitive impairment increased (SCD [15.7%], MCI [43.5%], and dementia [76.2%]), whereas it decreased as the severity of WMH increased (minimal [54.5%], moderate [53.9%], and severe [41.0%]) or the number of lacunes (0 [59.0%], 1-3 [42.0%], and >3 [23.4%]) increased. Aβ positivity was associated with higher education, absence of diabetes, and presence of ε4 after controlling for cognitive and WMH status.
Our analysis of Aβ positivity involving a large sample classified according to the stratified cognitive states and WMH severity indicates that Alzheimer and cerebral small vessel diseases lie on a continuum. Our results offer clinicians insightful information about the association among Aβ, WMH, and cognition.
我们研究了根据3种不同认知状态和3种不同程度的脑白质高信号（WMH，轻度、中度和重度）组合分类的9组中β-淀粉样蛋白（Aβ）阳性的频率，并旨在确定在控制WMH后哪些因素与Aβ相关，反之亦然。
从韩国首尔三星医疗中心的记忆诊所招募了总共1047名进行了Aβ PET扫描的主观认知下降（SCD，n = 294）、轻度认知障碍（MCI，n = 237）或痴呆（n = 516）患者。我们研究了以下内容：（1）9组中的Aβ阳性情况；（2）Aβ阳性与WMH严重程度之间的关系；（3）与Aβ或WMH独立相关的临床和遗传因素。
Aβ阳性率随着认知障碍严重程度的增加而升高（SCD [15.7%]，MCI [43.5%]，痴呆 [76.2%]），而随着WMH严重程度的增加（轻度 [54.5%]，中度 [53.9%]，重度 [41.0%]）或腔隙数量的增加（0个 [59.0%]，1 - 3个 [42.0%]，>3个 [23.4%]）而降低。在控制认知和WMH状态后，Aβ阳性与更高的教育程度、无糖尿病以及存在ε4相关。
我们对根据分层认知状态和WMH严重程度分类的大样本进行的Aβ阳性分析表明，阿尔茨海默病和脑小血管疾病处于连续统一体上。我们的结果为临床医生提供了关于Aβ、WMH和认知之间关联的有见地的信息。
