Tamura Yoshiaki, Shimoji Keigo, Ishikawa Joji, Murao Yuji, Yorikawa Fumino, Kodera Remi, Oba Kazuhito, Toyoshima Kenji, Chiba Yuko, Tokumaru Aya M, Araki Atsushi
Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
The Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
Front Aging Neurosci. 2022 Jul 27;14:912972. doi: 10.3389/fnagi.2022.912972. eCollection 2022.
Diffusion tensor imaging (DTI) can be used for the early detection of abnormal changes in the integrity of cerebral white matter tracts, and we have previously reported that these changes are associated with indices of early atherosclerotic lesions. Although these changes have been demonstrated to be associated with the incidence of frailty in older adults, no studies have investigated this relationship in patients at high risk for vascular disease. In this longitudinal study, we followed outpatients with cardiometabolic diseases for a maximum of 6 years (median, 3 years) and evaluated the association of baseline DTI data of seven white matter tracts with the incidence of frailty. The modified version of the Cardiovascular Health Study criteria and the Kihon Checklist were used as indices of frailty; fractional anisotropy (FA) and mean diffusivity (MD) were used as indices of white matter changes. Patients who developed frailty based on both indices had low FA and high MD in many of the tracts tested, with the most significant difference found in the MD of the anterior thalamic radiation (ATR). Cox proportional hazard model analysis revealed a significantly high risk of frailty defined by both indices in the groups with high MD values in the left ATR. Similar results were found in patients with diabetes mellitus but not in those without diabetes mellitus. Therefore, abnormalities in the integrity of the left ATR could be associated with the progression of frailty in older adults with cardiometabolic disease, particularly those with diabetes mellitus.
弥散张量成像（DTI）可用于早期检测脑白质纤维束完整性的异常变化，我们之前曾报道这些变化与早期动脉粥样硬化病变指标相关。尽管这些变化已被证明与老年人衰弱的发生率有关，但尚无研究在血管疾病高危患者中调查这种关系。在这项纵向研究中，我们对患有心脏代谢疾病的门诊患者进行了最长6年（中位数为3年）的随访，并评估了七条白质纤维束的基线DTI数据与衰弱发生率之间的关联。心血管健康研究标准的修订版和简易体能检查表被用作衰弱指标；分数各向异性（FA）和平均扩散率（MD）被用作白质变化指标。基于这两个指标出现衰弱的患者在许多测试纤维束中FA值较低而MD值较高，在前丘脑辐射（ATR）的MD中发现的差异最为显著。Cox比例风险模型分析显示，在左侧ATR中MD值较高的组中，由这两个指标定义的衰弱风险显著较高。在糖尿病患者中发现了类似结果，但在非糖尿病患者中未发现。因此，左侧ATR完整性异常可能与患有心脏代谢疾病的老年人，尤其是糖尿病患者的衰弱进展有关。
