脑小血管病进展与痴呆风险：一项 14 年随访研究。
Cerebral Small Vessel Disease Progression and the Risk of Dementia: A 14-Year Follow-Up Study.
机构信息
Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands, and Donders Center for Medical Neuroscience, Radboud University, Nijmegen (Jacob, Cai, van de Donk, Bergkamp, Tuladhar, de Leeuw); Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China (Cai); Center for Cognitive Neuroimaging, Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen (Marques, Norris); Center for Cognition, Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen (Kessels); Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands (Kessels); Department of Medical Psychology, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen (Kessels); Department of Geriatrics, Radboudumc Alzheimer Center, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen (Claassen); Department of Biomedical Engineering, Medical Image Analysis Center and Quantitative Biomedical Imaging Group (qbig), University of Basel, Basel, Switzerland (Duering).
出版信息
Am J Psychiatry. 2023 Jul 1;180(7):508-518. doi: 10.1176/appi.ajp.20220380. Epub 2023 Apr 19.
OBJECTIVE
Cerebral small vessel disease (SVD) is considered the most important vascular contributor to cognitive decline and dementia, although a causal relation between its MRI markers and dementia still needs to be established. The authors investigated the relation between baseline SVD severity as well as SVD progression on MRI markers and incident dementia, by subtype, in individuals with sporadic SVD over a follow-up period of 14 years.
METHODS
The study included 503 participants with sporadic SVD, and without dementia, from the prospective Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) study, with screening for baseline inclusion conducted in 2006. Follow-ups in 2011, 2015, and 2020 included cognitive assessments and MRI scans. Dementia was diagnosed according to DSM-5 criteria and stratified into Alzheimer's dementia and vascular dementia.
RESULTS
Dementia as an endpoint was available for 498 participants (99.0%) and occurred in 108 participants (21.5%) (Alzheimer's dementia, N=38; vascular dementia, N=34; mixed-etiology Alzheimer's dementia/vascular dementia, N=26), with a median follow-up time of 13.2 years (interquartile range, 8.8-13.8). Higher baseline white matter hyperintensity (WMH) volume (hazard ratio=1.31 per 1-SD increase, 95% CI=1.02-1.67), presence of diffusion-weighted-imaging-positive lesions (hazard ratio=2.03, 95% CI=1.01-4.04), and higher peak width of skeletonized mean diffusivity (hazard ratio=1.24 per 1-SD increase, 95% CI=1.02-1.51) were independently associated with all-cause dementia and vascular dementia. WMH progression predicted incident all-cause dementia (hazard ratio=1.76 per 1-SD increase, 95% CI=1.18-2.63).
CONCLUSIONS
Both baseline SVD severity and SVD progression were independently associated with an increase in risk of all-cause dementia over a follow-up of 14 years. The results suggest that SVD progression precedes dementia and may causally contribute to its development. Slowing SVD progression may delay dementia onset.
目的
脑小血管疾病（SVD）被认为是认知能力下降和痴呆最重要的血管危险因素，尽管其 MRI 标志物与痴呆之间的因果关系仍有待确定。作者通过对 503 名散发性 SVD 患者进行前瞻性拉德堡德大学奈梅亨弥散张量和磁共振队列研究（RUN DMC），在基线时筛查纳入标准，并在 2006 年进行了随访，以研究基线 SVD 严重程度以及 MRI 标志物上 SVD 的进展与偶发性 SVD 患者在 14 年的随访期间发生的痴呆（按亚型）之间的关系。
方法
该研究纳入了来自前瞻性拉德堡德大学奈梅亨弥散张量和磁共振队列研究（RUN DMC）的 503 名无痴呆症的散发性 SVD 患者，纳入标准筛查于 2006 年进行。2011 年、2015 年和 2020 年进行了随访，包括认知评估和 MRI 扫描。根据 DSM-5 标准诊断痴呆，并将其分为阿尔茨海默病痴呆和血管性痴呆。
结果
有 498 名参与者（99.0%）可获得痴呆作为终点，108 名参与者（21.5%）发生痴呆（阿尔茨海默病痴呆，N=38；血管性痴呆，N=34；混合病因阿尔茨海默病/血管性痴呆，N=26），中位随访时间为 13.2 年（四分位距，8.8-13.8）。较高的基线脑白质高信号（WMH）体积（危险比=每增加 1-SD 增加 1.31，95%可信区间[CI]=1.02-1.67）、弥散加权成像阳性病变的存在（危险比=2.03，95%CI=1.01-4.04）和骨架化平均弥散率峰值宽度较高（危险比=每增加 1-SD 增加 1.24，95%CI=1.02-1.51）与全因痴呆和血管性痴呆独立相关。WMH 进展预测全因痴呆的发生（危险比=每增加 1-SD 增加 1.76，95%CI=1.18-2.63）。
结论
基线 SVD 严重程度和 SVD 进展均与 14 年随访期间全因痴呆风险的增加独立相关。结果表明，SVD 进展先于痴呆，并可能因果导致其发展。减缓 SVD 进展可能会延迟痴呆的发生。
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