Kuipers Sanne, Willemse Sean W, Greving Jacoba P, Bron Esther E, van Oostenbrugge Robert J, van Osch Matthias J P, Biessels Geert Jan, Kappelle L Jaap
Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands.
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
Cereb Circ Cogn Behav. 2023 Jun 24;5:100169. doi: 10.1016/j.cccb.2023.100169. eCollection 2023.
Patients with carotid artery occlusion (CAO) are vulnerable to cognitive impairment (CI). Anaemia is associated with CI in the general population. We hypothesized that lower haemoglobin is associated with cognitive impairment (CI) in patients with CAO and that this association is accentuated by cerebral blood flow (CBF).
104 patients (mean age 66±8 years, 77% men) with complete CAO from the Heart-Brain Connection study were included. Anaemia was defined as haemoglobin < 12 g/dL for women and < 13 g/dL for men. Cognitive test results were standardized into z-scores (using a reference group) in four cognitive domains. Patients were classified as cognitively impaired when ≥ one domain was impaired. The association between lower haemoglobin and both cognitive domain z-scores and the presence of CI was assessed with adjusted (age, sex, education and ischaemic stroke) regression models. Total CBF (measured with phase contrast MRI) and the interaction term haemoglobin*CBF were additionally added to the analyses.
Anaemia was present in 6 (6%) patients and was associated with CI (RR 2.54, 95% CI 1.36; 4.76). Lower haemoglobin was associated with the presence of CI (RR per minus 1 g/dL haemoglobin 1.15, 95% CI 1.02; 1.30). This association was strongest for the attention-psychomotor speed domain (RR for impaired attention-psychomotor speed functioning per minus 1 g/dL haemoglobin 1.27, 95% CI 1.09;1.47) and ß for attention-psychomotor speed z-scores per minus 1 g/dL haemoglobin -0.19, 95% CI -0.33; -0.05). Adjustment for CBF did not affect these results and we found no interaction between haemoglobin and CBF in relation to cognition.
Lower haemoglobin concentrations are associated with CI in patients with complete CAO, particularly in the domain attention-psychomotor speed. CBF did not accentuate this association. If validated in longitudinal studies, haemoglobin might be a viable target to prevent cognitive deterioration in patients with CAO.
颈动脉闭塞（CAO）患者易发生认知障碍（CI）。在普通人群中，贫血与认知障碍相关。我们假设，血红蛋白水平较低与CAO患者的认知障碍相关，且这种关联会因脑血流量（CBF）而加剧。
纳入了心脏-大脑连接研究中的104例完全性CAO患者（平均年龄66±8岁，77%为男性）。贫血定义为女性血红蛋白<12 g/dL，男性血红蛋白<13 g/dL。认知测试结果在四个认知领域被标准化为z分数（使用参考组）。当≥一个领域受损时，患者被分类为认知障碍。使用校正（年龄、性别、教育程度和缺血性卒中）回归模型评估较低血红蛋白与认知领域z分数以及认知障碍存在之间的关联。分析中还额外加入了总脑血流量（用相位对比MRI测量）以及血红蛋白*脑血流量的交互项。
6例（6%）患者存在贫血，且与认知障碍相关（风险比2.54，95%置信区间1.36；4.76）。较低的血红蛋白与认知障碍的存在相关（每降低1 g/dL血红蛋白的风险比为1.15，95%置信区间1.02；1.30）。这种关联在注意力-精神运动速度领域最为明显（每降低1 g/dL血红蛋白，注意力-精神运动速度功能受损的风险比为1.27，95%置信区间1.09；1.47），以及每降低1 g/dL血红蛋白，注意力-精神运动速度z分数的β值为-0.19，95%置信区间-0.33；-0.05）。校正脑血流量并不影响这些结果，并且我们未发现血红蛋白与脑血流量在认知方面存在交互作用。
血红蛋白浓度较低与完全性CAO患者的认知障碍相关，尤其是在注意力-精神运动速度领域。脑血流量并未加剧这种关联。如果在纵向研究中得到验证，血红蛋白可能是预防CAO患者认知衰退的一个可行靶点。
