Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, No.1650, Sect. 4, Taiwan Boulevard, Taichung, 40705, Taiwan.
Dementia Center, Taichung Veterans General Hospital, Taichung, Taiwan.
Alzheimers Res Ther. 2022 Sep 30;14(1):141. doi: 10.1186/s13195-022-01083-8.
Both cerebral amyloid angiopathy (CAA) and hypertensive arteriopathy (HA) are related to cognitive impairment and dementia. This study aimed to clarify CAA- and HA-related small vessel disease (SVD) imaging marker associations with cognitive dysfunction and Alzheimer disease (AD) subtypes.
A sample of 137 subjects with clinically diagnosed late-onset AD identified from the dementia registry of a single center from January 2017 to October 2021 were enrolled. Semi-quantitative imaging changes (visual rating scale grading) suggestive of SVD were analyzed singularly and compositely, and their correlations with cognitive domains and AD subtypes were examined.
Patients with typical and limbic-predominant AD subtypes had worse cognitive performance and higher dementia severity than minimal-atrophy subtype patients. Deep white matter hyperintensity (WMH) presence correlated inversely with short-term memory (STM) performance. The three composite SVD scores correlated with different cognitive domains and had distinct associations with AD subtypes. After adjusting for relevant demographic factors, multivariate logistic regression (using minimal-atrophy subtype as the reference condition) revealed the following: associations of the typical subtype with periventricular WMH [odds ratio (OR) 2.62; 95% confidence interval (CI), 1.23-5.57, p = 0.012], global SVD score (OR 1.67; 95%CI, 1.11-2.52, p = 0.009), and HA-SVD score (OR 1.93; 95%CI, 1.10-3.52, p = 0.034); associations of limbic-predominant subtype with HA-SVD score (OR 2.57; 95%CI, 1.23-5.37, p = 0.012) and most global and domain-specific cognitive scores; and an association of hippocampal-sparing subtype with HA-SVD score (OR 3.30; 95%CI, 1.58-6.85, p = 0.001).
Composite SVD imaging markers reflect overall CAA and/or HA severity and may have differential associations with cognitive domains and AD subtypes. Our finding supports the possibility that the clinical AD subtypes may reflect differing burdens of underlying CAA and HA microangiopathologies.
脑淀粉样血管病（CAA）和高血压性血管病（HA）均与认知障碍和痴呆有关。本研究旨在阐明与 CAA 和 HA 相关的小血管疾病（SVD）影像学标志物与认知功能障碍和阿尔茨海默病（AD）亚型的关系。
本研究纳入了 2017 年 1 月至 2021 年 10 月期间，从单一中心的痴呆登记处诊断为迟发性 AD 的 137 名患者。对提示 SVD 的半定量影像学改变（视觉评分量表分级）进行单独和综合分析，并探讨其与认知领域和 AD 亚型的相关性。
与最小萎缩型患者相比，具有典型和边缘优势 AD 亚型的患者认知表现更差，痴呆严重程度更高。深部脑白质高信号（WMH）的存在与短期记忆（STM）表现呈负相关。三个复合 SVD 评分与不同的认知领域相关，与 AD 亚型有明显的关联。在调整相关人口统计学因素后，多元逻辑回归（以最小萎缩型作为参考条件）显示以下结果：典型亚型与脑室周围 WMH 相关（比值比 [OR] 2.62；95%置信区间 [CI]，1.23-5.57，p=0.012），与全球 SVD 评分（OR 1.67；95%CI，1.11-2.52，p=0.009）和 HA-SVD 评分（OR 1.93；95%CI，1.10-3.52，p=0.034）相关；边缘优势亚型与 HA-SVD 评分（OR 2.57；95%CI，1.23-5.37，p=0.012）和大多数全球及特定领域认知评分相关；而海马保留型与 HA-SVD 评分（OR 3.30；95%CI，1.58-6.85，p=0.001）相关。
复合 SVD 影像学标志物反映了整体 CAA 和/或 HA 的严重程度，可能与认知领域和 AD 亚型有不同的关联。我们的发现支持了这样一种可能性，即临床 AD 亚型可能反映了不同的潜在 CAA 和 HA 微血管病变负担。
