Qiao Yanan, He Xuwen, Zhang Junying, Liang Ying, Shao Wen, Zhang Zhanjun, Zhang Sihang, Peng Dantao
Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.
Front Aging Neurosci. 2021 Aug 2;13:681208. doi: 10.3389/fnagi.2021.681208. eCollection 2021.
Emerging evidence suggests that white matter (WM) disruption is associated with the incidence of subcortical vascular cognitive impairment (SVCI). However, our knowledge regarding this relationship in the early stage of SVCI is limited. We aimed to investigate the associations between WM disruptions and cognitive declines at the early stage of SVCI.
We performed a case-control study, involving 22 cases and 19 controls. The cases were patients at the early stage of SVCI, which was defined as subcortical ischemic vascular disease with normal global cognitive measures (pre-SVCI). The controls were healthy people matched by age, sex, and education years. We assessed the differences in a battery of neuropsychological tests between the two groups, investigated the diffusion changes in 40 WM tracts among the participants an atlas-based segmentation strategy, and compared the differences between the cases and controls by multiple linear regression analysis. We then evaluated the relationships between diffusion indices and cognitive assessment scores by Pearson's correlation.
The pre-SVCI group exhibited significant differences in the Montreal cognitive assessment (MoCA), Rey-Osterrieth Complex Figure (R-O)-copy, and Trail Making Test (TMT)-B test compared with the controls. Compared with the controls, some long associative and projective bundles, such as the right anterior corona radiata (ACR), the right inferior fronto-occipital fasciculus (IFOF), and the left external capsule (EC), were extensively damaged in cases after Bonferroni correction ( < 0.05/40). Damages to specific fibers, such as the right ACR, IFOF, and posterior thalamic radiation (PTR), exhibited significant correlations with declines in MoCA, R-O delay, and the Mini-Mental State Examination (MMSE), respectively, after Bonferroni correction ( < 0.05/14).
Long WM tracts, especially those in the right hemisphere, were extensively damaged in the pre-SVCI patients and correlated with declines in executive functions and spatial processing. Patients of pre-SVCI are likely at an ultra-early stage of SVCI, and there is a very high risk of this condition becoming SVCI.
新出现的证据表明，白质（WM）破坏与皮质下血管性认知障碍（SVCI）的发病率相关。然而，我们对SVCI早期阶段这种关系的了解有限。我们旨在研究SVCI早期阶段WM破坏与认知衰退之间的关联。
我们进行了一项病例对照研究，包括22例病例和19例对照。病例为SVCI早期患者，定义为具有正常整体认知测量的皮质下缺血性血管疾病（SVCI前期）。对照为年龄、性别和受教育年限相匹配的健康人。我们评估了两组在一系列神经心理学测试中的差异，采用基于图谱的分割策略研究了参与者中40条WM束的扩散变化，并通过多元线性回归分析比较了病例组和对照组之间的差异。然后，我们通过Pearson相关性评估了扩散指数与认知评估分数之间的关系。
与对照组相比，SVCI前期组在蒙特利尔认知评估（MoCA）、雷-奥斯特里思复杂图形（R-O）临摹和连线测验（TMT）-B测试中表现出显著差异。与对照组相比，一些长联合束和投射束，如右侧放射冠前部（ACR）、右侧额枕下束（IFOF）和左侧外囊（EC），在Bonferroni校正后（<0.05/40）在病例中受到广泛损伤。右侧ACR、IFOF和丘脑后辐射（PTR）等特定纤维的损伤，在Bonferroni校正后（<0.05/14），分别与MoCA下降、R-O延迟和简易精神状态检查表（MMSE）下降显著相关。
在SVCI前期患者中，长WM束，尤其是右侧半球的长WM束受到广泛损伤，并与执行功能和空间处理能力下降相关。SVCI前期患者可能处于SVCI的超早期阶段，这种情况发展为SVCI的风险非常高。
