Li Chunmei, Chen Yuhui, Wu Pu-Yeh, Wu Bing, Gong Tao, Wang Hua, Chen Min
Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Quant Imaging Med Surg. 2021 Jun;11(6):2560-2571. doi: 10.21037/qims-20-852.
Frailty is a geriatric condition characterized by a decreased reserve. The Edmonton frailty scale (EFS) has been widely used as an assessment tool in clinical practice. However, the brain's underlying pathophysiological changes in frailty and their associations with the EFS remain unclear. This study aimed to explore the associations between brain volumetry and relaxometry signatures and the EFS (and each domain score of the EFS) in frailty.
A total of 40 non-demented subjects were enrolled in this prospective study. Frailty assessment was performed for each subject according to the EFS. All subjects underwent synthetic magnetic resonance imaging (MRI) (MAGnetic resonance image Compilation, MAGiC) and three-dimensional fast spoiled gradient-recalled echo (3D-FSPGR) T1-weighted structural image acquisitions on a 3.0 T MR scanner. Brain segmentation was performed based on quantitative values obtained from the MAGiC and 3D-FSPGR images. Volumetry and relaxometry of the global brain and regional gray matter (GM) were also obtained. The associations between the total EFS score (and the score of each domain) and the brain's volumetry and relaxometry were investigated by partial correlation while eliminating the effects of age. Multiple comparisons of regional GM volumetry and relaxometry analyses were controlled by false discovery rate (FDR) correction. All data were analyzed using the SPSS 13.0 statistical package (IBM, Armonk, NY, USA) and MATLAB (MathWorks, Natick, MA, USA).
For global volumetry, significant correlations were found between multiple global volumetry parameters and the EFS, as well as the cognition score, functional independence score, nutrition score, and functional performance score (P<0.05). For global relaxometry, notable positive correlations were found between the T2 values of gray and white matter (WM) and the EFS (r=0.357, P=0.026; r=0.357, P=0.026, respectively). Significant correlations were also identified between the T2 value of GM, the T1, T2, and PD values of WM, and the cognition score (r=0.426, P=0.007; r=0.456, P=0.003; r=0.377, P=0.018; r=0.424, P=0.007, respectively), functional independence score (r=-0.392, P=0.014; r=-0.611, P<0.001; r=-0.367, P=0.022; r=-0.569, P<0.001, respectively), and functional performance score (r=0.337, P=0.036; r=0.472, P=0.002; r=0.354, P=0.027; r=0.376, P=0.018, respectively). For regional GM volumetry, multiple regions showed significant negative correlations with the EFS (P<0.05). Notable negative correlations were found between multiple regional GM volume and the functional independence score (P<0.05). For regional GM relaxometry, the T1 and T2 values of several regions showed significant negative correlations with the functional independence score (T1 value of caudate, r=-0.617, P<0.001; T2 value of insula, r=-0.510, P=0.015; T2 value of caudate, r=-0.633, P<0.001, respectively). No significant correlation was found between the domain scores of the EFS and regional GM PD values (P>0.05).
In conclusion, brain volumetry and relaxometry signatures showed strong associations with the EFS and some EFS domain scores in frailty. These associations may reveal the possible underlying pathophysiology of the EFS and different domains of the EFS.
衰弱是一种以储备能力下降为特征的老年疾病。埃德蒙顿衰弱量表（EFS）在临床实践中已被广泛用作评估工具。然而，衰弱时大脑潜在的病理生理变化及其与EFS的关联仍不清楚。本研究旨在探讨脑容量测定和弛豫测定特征与衰弱中的EFS（以及EFS的每个领域得分）之间的关联。
本前瞻性研究共纳入40名非痴呆受试者。根据EFS对每位受试者进行衰弱评估。所有受试者均在3.0 T MR扫描仪上进行了合成磁共振成像（MRI）（磁共振图像合成，MAGiC）和三维快速扰相梯度回波（3D-FSPGR）T1加权结构图像采集。基于从MAGiC和3D-FSPGR图像获得的定量值进行脑部分割。还获得了全脑和区域灰质（GM）的容量测定和弛豫测定。通过偏相关分析，在消除年龄影响的同时，研究EFS总分（以及每个领域的得分）与脑容量测定和弛豫测定之间的关联。区域GM容量测定和弛豫测定分析的多重比较通过错误发现率（FDR）校正进行控制。所有数据均使用SPSS 13.0统计软件包（美国纽约州阿蒙克市IBM公司）和MATLAB（美国马萨诸塞州纳蒂克市MathWorks公司）进行分析。
对于全脑容量测定，多个全脑容量参数与EFS以及认知得分、功能独立性得分（FIS）、营养得分和功能表现得分之间存在显著相关性（P<0.05）。对于全脑弛豫测定，灰质和白质（WM）的T2值与EFS之间存在显著正相关（分别为r = 0.357，P = 0.026；r = 0.357，P = 0.026）。GM的T2值、WM的T1、T2和质子密度（PD）值与认知得分（分别为r = 0.426，P = 0.007；r = 0.456，P = 0.003；r = 0.377，P = 0.018；r = 0.424，P = 0.007）、功能独立性得分（分别为r = -0.392，P = 0.014；r = -0.611，P<0.001；r = -0.367，P = 0.022；r = -0.569，P<0.001）和功能表现得分（分别为r = 0.337，P = 0.036；r = 0.472，P = 0.002；r = 0.354，P = 0.027；r = 0.376，P = 0.018）之间也存在显著相关性。对于区域GM容量测定，多个区域与EFS呈显著负相关（P<0.05）。多个区域GM体积与功能独立性得分之间存在显著负相关（P<0.05）。对于区域GM弛豫测定，几个区域的T1和T2值与功能独立性得分呈显著负相关（尾状核的T1值，r = -0.617，P<0.001；岛叶的T2值，r = -0.510，P = 0.015；尾状核的T2值，r = -0.633，P<0.001）。EFS各领域得分与区域GM PD值之间未发现显著相关性（P>0.05）。
总之，脑容量测定和弛豫测定特征与衰弱中的EFS及一些EFS领域得分密切相关。这些关联可能揭示了EFS及其不同领域潜在的病理生理学机制。
