From the Department of Neurology (D.A.F., G.J.B.), UMC Utrecht Brain Center, and Image Sciences Institute (H.J.K., D.v.V.), University Medical Center Utrecht, the Netherlands; Memory Aging and Cognition Centre (S.H., C.C.), Department of Pharmacology, National University of Singapore; Department of Neurology (S.J.v.V.), J.P.K. Stroke Research Center, Massachusetts General Hospital, Boston; Raffles Neuroscience Center (N.V.), Raffles Hospital; and St. Luke's Hospital (B.Y.T.), Singapore.
Neurology. 2022 Feb 8;98(6):e612-e622. doi: 10.1212/WNL.0000000000013140. Epub 2021 Dec 3.
Cerebral cortical microinfarcts (CMIs) are a novel MRI marker of cerebrovascular disease (CeVD) that predicts accelerated cognitive decline. Presence of CMIs is known to be associated with global cortical atrophy, although the mechanism linking the two is unclear. Our primary objective was to examine the relation between CMIs and cortical atrophy and to establish possible perilesional atrophy surrounding CMIs. Our secondary objective was to examine the role of cortical atrophy in CMI-associated cognitive impairment.
Patients were recruited from 2 Singapore memory clinics between December 2010 and September 2013 and included if they received the diagnosis no objective cognitive impairment, cognitive impairment (with or without a history of stroke), or Alzheimer or vascular dementia. Cortical thickness, chronic CMIs, and MRI markers of CeVD were assessed on 3T MRI. Patients underwent cognitive testing. Cortical thickness was compared globally between patients with and without CMIs, regionally within individual patients with CMIs comparing brain regions with CMIs to the corresponding contralateral region without CMIs, and locally within individuals patients in a 50-mm radius of CMIs. Global cortical thickness was analyzed as mediator in the relation between CMI and cognitive performance.
Of the 238 patients (mean age 72.5 years, SD 9.1 years) enrolled, 75 had ≥1 CMIs. Patient with CMIs had a 2.1% lower global cortical thickness (B = -0.049 mm, 95% confidence interval [CI] 0.091 to -0.007, = 0.022) compared to patients without CMIs, after correction for age, sex, education, and intracranial volume. In patients with CMIs, cortical thickness in brain regions with CMIs was 2.2% lower than in contralateral regions without CMIs (B = -0.048 mm [95% CI -0.071 to -0.026], 0.001). In a 20-mm radius area surrounding the CMI core, cortical thickness was lower than in the area 20 to 50 mm from the CMI core (mean difference -0.06 mm [-0.10 to -0.02], = 0.002). Global cortical thickness was a significant mediator in the relationship between CMI presence and cognitive performance as measure with the Mini-Mental State Examination (B = -0.12 [-0.22 to -0.01], 0025).
We found cortical atrophy surrounding CMIs, suggesting a perilesional effect in a cortical area many times larger than the CMI core. Our findings support the notion that CMIs affect brain structure beyond the actual lesion site.
脑皮质微梗死（CMIs）是一种新的脑血管疾病（CeVD）的 MRI 标志物，可预测认知能力加速下降。已知 CMIs 与全皮质萎缩有关，尽管两者之间的联系机制尚不清楚。我们的主要目的是检查 CMIs 与皮质萎缩之间的关系，并确定 CMIs 周围可能存在的皮质旁萎缩。我们的次要目的是研究皮质萎缩在与 CMIs 相关的认知障碍中的作用。
我们招募了 2010 年 12 月至 2013 年 9 月期间在 2 家新加坡记忆诊所的患者，如果他们被诊断为无客观认知障碍、认知障碍（伴或不伴卒中史）、阿尔茨海默病或血管性痴呆，则纳入研究。在 3T MRI 上评估皮质厚度、慢性 CMIs 和 CeVD 的 MRI 标志物。患者接受认知测试。在全球范围内，比较了有和无 CMIs 的患者之间的皮质厚度；在有 CMIs 的患者中，在个体患者的区域内，比较了有 CMIs 的脑区与无 CMIs 的相应对侧脑区之间的皮质厚度；在有 CMIs 的个体患者中，在 CMIs 周围 50mm 半径范围内的局部进行比较。分析皮质厚度作为 CMIs 与认知表现之间关系的中介。
在 238 名（平均年龄 72.5 岁，标准差 9.1 岁）患者中，75 名患者有≥1 个 CMIs。与无 CMIs 的患者相比，有 CMIs 的患者皮质厚度低 2.1%（B=-0.049mm，95%置信区间 [CI]0.091 至 -0.007， = 0.022），校正年龄、性别、教育程度和颅内体积后。在有 CMIs 的患者中，有 CMIs 的脑区皮质厚度比无 CMIs 的对侧脑区低 2.2%（B=-0.048mm[95%CI-0.071 至 -0.026]， 0.001）。在 CMIs 核心周围 20mm 区域内，皮质厚度低于距 CMIs 核心 20-50mm 的区域（平均差异-0.06mm[-0.10 至 -0.02]， 0.002）。皮质厚度作为 Mini-Mental State Examination （MMSE）测量认知表现的中介物，在 CMIs 存在与认知表现之间的关系中具有统计学意义（B=-0.12[-0.22 至 -0.01]， 0.025）。
我们发现 CMIs 周围存在皮质萎缩，表明在比 CMIs 核心大得多的皮质区域存在皮质旁效应。我们的发现支持这样一种观点，即 CMIs 会影响大脑结构，而不仅仅是实际病变部位。
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