Nannoni Stefania, Ohlmeier Laura, Brown Robin B, Morris Robin G, MacKinnon Andrew D, Markus Hugh S
Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Int J Stroke. 2022 Apr;17(4):415-424. doi: 10.1177/17474930211012837. Epub 2021 May 7.
Whether cerebral microbleeds cause cognitive impairment remains uncertain. We analyzed whether cerebral microbleeds are associated with cognitive dysfunction in patients with symptomatic cerebral small vessel disease, and whether this association is independent of other neuroimaging markers of cerebral small vessel disease.
We analyzed consecutive patients with MRI-confirmed lacunar stroke included in DNA-Lacunar-2 multicenter study. Cerebral microbleeds were graded using the Brain Observer Microbleed Rating Scale (BOMBS). Neuropsychological assessment was performed using the Brief Memory and Executive Test (BMET). We analyzed the association between cerebral microbleeds, BMET, and the following subdomains: executive function/processing speed and orientation/memory. We also searched for an independent association between cerebral microbleeds and vascular cognitive impairment, defined as BMET ≤ 13.
Out of 688 included patients, cerebral microbleeds were detected in 192 (27.9%). After adjusting for white matter hyperintensities severity, lacune count, and other confounders, both the presence and the number of cerebral microbleeds were significantly associated with impaired cognitive performance [β = -13.0; 95% CI = (-25.3, -0.6) and β = -13.1; 95% CI = (-19.8, -6.4), respectively]. On analysis of specific cognitive domains, associations were present for executive function/processing speed [β = -5.8; 95% CI = (-9.3, -2.2) and β = -4.3; 95% CI = (-6.2, -2.4), respectively] but not for orientation/memory [β = -0.4; 95% CI = (-4.0, 3.2) and β = -2.1; 95% CI = (-4.0, 0.1), respectively]. We also found an independent association between the presence and the number of cerebral microbleeds and vascular cognitive impairment [adjusted OR = 1.48; 95% CI = (1.01, 2.18) and OR = 1.43; 95% CI = (1.15, 1.79), respectively].
In a large cohort of symptomatic cerebral small vessel disease patients, after controlling for other neuroimaging markers of cerebral small vessel disease severity, cerebral microbleeds were associated with cognitive dysfunction. Executive function and processing speed were predominantly impaired. This might suggest a causal role of cerebral microbleeds in determining vascular cognitive impairment.
脑微出血是否会导致认知障碍仍不确定。我们分析了有症状的脑小血管疾病患者中脑微出血是否与认知功能障碍相关，以及这种关联是否独立于脑小血管疾病的其他神经影像学标志物。
我们分析了纳入DNA-Lacunar-2多中心研究的连续MRI确诊的腔隙性卒中患者。使用脑微出血观察评分量表（BOMBS）对脑微出血进行分级。使用简易记忆与执行功能测试（BMET）进行神经心理学评估。我们分析了脑微出血、BMET与以下子领域之间的关联：执行功能/处理速度以及定向/记忆。我们还探寻了脑微出血与血管性认知障碍（定义为BMET≤13）之间的独立关联。
在纳入的688例患者中，192例（27.9%）检测到脑微出血。在调整了白质高信号严重程度、腔隙数量及其他混杂因素后，脑微出血的存在及数量均与认知功能受损显著相关[β=-13.0；95%可信区间=（-25.3，-0.6）和β=-13.1；95%可信区间=（-19.8，-6.4）]。在特定认知领域分析中，执行功能/处理速度存在关联[β=-5.8；95%可信区间=（-9.3，-2.2）和β=-4.3；95%可信区间=（-6.2，-2.4）]，但定向/记忆不存在关联[β=-0.4；95%可信区间=（-4.0，3.2）和β=-2.1；95%可信区间=（-4.0，0.1）]。我们还发现脑微出血的存在及数量与血管性认知障碍之间存在独立关联[调整后的比值比=1.48；95%可信区间=（1.01，2.18）和比值比=1.43；95%可信区间=（1.15，1.79）]。
在一大群有症状的脑小血管疾病患者中，在控制了脑小血管疾病严重程度的其他神经影像学标志物后，脑微出血与认知功能障碍相关。主要受损的是执行功能和处理速度。这可能表明脑微出血在确定血管性认知障碍中起因果作用。
