From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea.
Neurology. 2022 Sep 27;99(13):e1414-e1421. doi: 10.1212/WNL.0000000000200910. Epub 2022 Jun 28.
Although enlarged perivascular spaces (EPVS) have been suggested as an emerging measure of small vessel disease (SVD) in the brain, their association with cognitive impairment is not yet clearly understood. We aimed to examine the relationship between each EPVS in the basal ganglia (BG-EPVS) and centrum semiovale (CSO-EPVS) with cognition in a memory clinic population.
Participants with a diverse cognitive spectrum were recruited from a university hospital memory clinic. They underwent comprehensive clinical and neuropsychological assessments and brain MRI. BG-EPVS and CSO-EPVS were measured on T2-weighted MRI and then dichotomized into low and high degrees for further analyses. Other SVD markers were assessed using validated rating scales.
A total of 910 participants were included in this study. A high degree of BG-EPVS was significantly associated with poorer scores on the executive function domain, but not with other cognitive domains, when age, sex, education, MRI scanner type, and cognitive diagnosis were controlled as covariates. However, the association between BG-EPVS and executive function was no longer significant after controlling for other markers of SVD, such as lacunar infarcts and periventricular white matter hyperintensities, as additional covariates. CSO-EPVS did not have a significant relationship with any cognitive scores, regardless of the covariates.
Our findings from a large memory clinic population suggest that EPVS, regardless of the topographical location, may not be used as a specific SVD marker for cognitive impairment, although an apparent association was observed between a high degree of BG-EPVS and executive dysfunction before controlling other SVD markers that share a common pathophysiologic process with BG-EPVS.
尽管增大的血管周围间隙（EPVS）已被提出作为脑小血管病（SVD）的一种新的测量指标，但它们与认知障碍的关系尚不清楚。我们旨在检查基底节（BG-EPVS）和半卵圆中心（CSO-EPVS）中的每个 EPVS 与记忆门诊人群认知功能的关系。
从大学医院记忆门诊招募了具有不同认知谱的参与者。他们接受了全面的临床和神经心理学评估以及脑 MRI 检查。在 T2 加权 MRI 上测量 BG-EPVS 和 CSO-EPVS，然后将其分为低度和高度进行进一步分析。使用经过验证的评分量表评估其他 SVD 标志物。
共有 910 名参与者纳入本研究。当控制年龄、性别、教育程度、MRI 扫描仪类型和认知诊断等协变量时，BG-EPVS 程度较高与执行功能域的评分较差显著相关，但与其他认知域无关。然而，当将 SVD 的其他标志物（如腔隙性梗死和脑室周围白质高信号）作为附加协变量进行控制后，BG-EPVS 与执行功能之间的关联不再显著。CSO-EPVS 与任何认知评分均无显著关系，无论是否存在协变量。
我们从大型记忆门诊人群中得出的发现表明，EPVS，无论其位置如何，可能不能作为认知障碍的特定 SVD 标志物，尽管在控制与 BG-EPVS 具有共同病理生理过程的其他 SVD 标志物之前，BG-EPVS 程度较高与执行功能障碍之间存在明显关联。
