年龄对脑脊液腔隙的影响：高凸面和内侧蛛网膜下腔隙随年龄增长而减小。
Impact of age on the cerebrospinal fluid spaces: high-convexity and medial subarachnoid spaces decrease with age.
机构信息
Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan.
Department of Neuropsychiatry, Faculty of Medicine, Kindai University, Osaka, Japan.
出版信息
Fluids Barriers CNS. 2022 Oct 28;19(1):82. doi: 10.1186/s12987-022-00381-5.
BACKGROUND
Impaired cerebrospinal fluid (CSF) dynamics may contribute to the pathophysiology of neurodegenerative diseases, and play a crucial role in brain health in older people; nonetheless, such age-related changes have not been well elucidated. Disproportionately enlarged subarachnoid-space hydrocephalus (DESH) is a neuroimaging phenotype of idiopathic normal-pressure hydrocephalus, originating from impaired CSF dynamics, and closely associated with aging. This study aimed to investigate the pathophysiology of DESH and determine age-related changes in CSF dynamics.
METHODS
Using magnetic resonance imaging, we investigated the pathophysiology of DESH by quantitatively evaluating the volumes of DESH-related regions (ventricles [VS], Sylvian fissure [SF], and subarachnoid spaces at high convexity and midline [SHM]) and brain parenchyma in community-dwelling individuals aged ≥ 65 years. DESH-related regions were assessed using a visual rating scale, and volumes measured using voxel-based morphometry. Brain parenchyma volumes were measured using FreeSurfer software.
RESULTS
Data from 1,356 individuals were analyzed, and 25 (1.8%) individuals had DESH. Regarding the relationships between the volume of each CSF space and age, VS and SF volumes increased with age, whereas SHM volume did not increase. VS and SF volumes increased as the whole brain volume decreased, whereas SHM volume did not increase even if the whole brain volume decreased; that is, SHM did not expand even if brain atrophy progressed. Moreover, lower Mini-Mental State Examination scores were significantly associated with lower SHM volume and higher VS volume. These associations remained significant even when individuals with DESH were excluded.
CONCLUSIONS
This study showed that the volume of high-convexity and medial subarachnoid spaces did not expand and tended to decrease with age; the human brain continuously progresses toward a "DESH-like" morphology with aging in community-dwelling older persons (i.e., DESH might be an "accelerated aging stage" rather than an "age-related disorder"). Our results indicated that brain atrophy may be associated with the development of "DESH-like" morphology. In addition, this morphological change, as well as brain atrophy, is an important condition associated with cognitive decline in older adults. Our findings highlight the importance of investigating the aging process of CSF dynamics in the human brain to preserve brain health in older people.
背景
脑脊液（CSF）动力学受损可能导致神经退行性疾病的病理生理学，并在老年人的大脑健康中发挥关键作用；尽管如此，这种与年龄相关的变化尚未得到充分阐明。蛛网膜下腔不成比例增大性脑积水（DESH）是特发性正常压力性脑积水的神经影像学表型，源于 CSF 动力学受损，与衰老密切相关。本研究旨在探讨 DESH 的病理生理学，并确定 CSF 动力学的年龄相关性变化。
方法
我们使用磁共振成像，通过定量评估与 DESH 相关的区域（脑室[VS]、大脑外侧裂[SF]和高凸面和中线的蛛网膜下腔[SHM]）以及社区居住的年龄≥65 岁个体的脑实质的体积，来研究 DESH 的病理生理学。使用视觉评分量表评估与 DESH 相关的区域，并使用体素形态计量学测量体积。使用 FreeSurfer 软件测量脑实质体积。
结果
对 1356 名个体的数据进行了分析，其中 25 名（1.8%）个体患有 DESH。关于每个 CSF 空间的体积与年龄之间的关系，VS 和 SF 的体积随年龄的增长而增加，而 SHM 体积没有增加。VS 和 SF 体积随着全脑体积的减少而增加，而 SHM 体积即使全脑体积减少也没有增加；也就是说，即使脑萎缩进展，SHM 也不会扩张。此外，较低的简易精神状态检查分数与较低的 SHM 体积和较高的 VS 体积显著相关。即使排除了患有 DESH 的个体，这些关联仍然显著。
结论
本研究表明，高凸面和中线蛛网膜下腔的体积没有扩大，并且随着年龄的增长有减小的趋势；在社区居住的老年人中，大脑不断向“DESH 样”形态发展（即，DESH 可能是一种“加速衰老阶段”，而不是一种“与年龄相关的疾病”）。我们的结果表明，脑萎缩可能与“DESH 样”形态的发展有关。此外，这种形态变化以及脑萎缩是与老年人认知能力下降相关的重要条件。我们的发现强调了研究人脑 CSF 动力学衰老过程以保护老年人大脑健康的重要性。
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