Zhang Sen, Hu Yaya, Yang Huilin, Li Qianqian, Chen Jing, Bai Hongying
Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Aging Neurosci. 2023 Mar 31;15:1096808. doi: 10.3389/fnagi.2023.1096808. eCollection 2023.
White matter hyperintensities (WMH) are a key imaging feature of cerebral small-vessel disease (CSVD). However, there is a lack of standardized methods for determining WMH volume, and the value of total white matter (WM) volume in the assessment of cognitive impairment in patients with CSVD remains unknown.
We aimed to explore the correlations of WMH volume and WM volume with cognitive dysfunction and its components in patients with CSVD. We also aimed to compare the value of the Fazekas score, WMH volume, and ratio of WMH volume to total WM volume in the assessment of cognitive dysfunction.
The study included 99 patients with CSVD. Patients were categorized into following groups based on MoCA scores: patients with mild cognitive impairment and those without. Brain magnetic resonance images were processed to investigate differences in WMH and WM volumes between the groups. Logistic regression analysis was used to determine whether these two factors were independent risk factors for cognitive dysfunction. Correlation analysis was used to examine the relationships of WMH and WM volume with different types of cognitive impairment. Receiver operating characteristic curves were used to compare the effectiveness of the WMH score, WMH volume, and WMH to WM ratio for evaluating cognitive dysfunction.
There were significant differences in age, education level, WMH volume, and WM volume between the groups ( < 0.05). After adjusting for age and education, the multivariate logistic analysis indicated that both WMH volume and WM volume were independent risk factors for cognitive dysfunction. Correlation analysis indicated that WMH volume was mainly related to cognition involving the visual space and delayed recall. WM volume was not strongly associated with different types of cognitive dysfunction. The WMH to WM ratio was the strongest predictor, with an area under the curve value of 0.800 and a 95% confidence interval of 0.710-0.891.
Increases in WMH volume may aggravate cognitive dysfunction in patients with CSVD, and a higher WM volume may reduce the effect of WMH volume on cognitive function to a certain extent. The ratio of WMH to total WM volume may reduce the impact of brain atrophy, allowing for more accurate evaluation of cognitive dysfunction in older adults with CSVD.
脑白质高信号（WMH）是脑小血管病（CSVD）的关键影像学特征。然而，目前缺乏标准化的WMH体积测定方法，且全脑白质（WM）体积在CSVD患者认知障碍评估中的价值仍不明确。
我们旨在探讨CSVD患者中WMH体积和WM体积与认知功能障碍及其组成部分之间的相关性。我们还旨在比较Fazekas评分、WMH体积以及WMH体积与全脑WM体积之比在评估认知功能障碍中的价值。
该研究纳入了99例CSVD患者。根据蒙特利尔认知评估量表（MoCA）评分将患者分为以下两组：轻度认知障碍患者和无认知障碍患者。对脑部磁共振图像进行处理，以研究两组之间WMH和WM体积的差异。采用逻辑回归分析确定这两个因素是否为认知功能障碍的独立危险因素。采用相关性分析来检验WMH和WM体积与不同类型认知障碍之间的关系。使用受试者工作特征曲线来比较WMH评分、WMH体积以及WMH与WM之比在评估认知功能障碍方面的有效性。
两组在年龄、教育水平、WMH体积和WM体积方面存在显著差异（<0.05）。在对年龄和教育水平进行校正后，多因素逻辑分析表明，WMH体积和WM体积均为认知功能障碍的独立危险因素。相关性分析表明，WMH体积主要与涉及视觉空间和延迟回忆的认知相关。WM体积与不同类型的认知功能障碍无强烈关联。WMH与WM之比是最强的预测指标，曲线下面积值为0.800，95%置信区间为0.710 - 0.891。
WMH体积增加可能会加重CSVD患者的认知功能障碍，而较高的WM体积可能在一定程度上降低WMH体积对认知功能的影响。WMH与全脑WM体积之比可能会减少脑萎缩的影响，从而更准确地评估老年CSVD患者的认知功能障碍。
