进展性和稳定性轻度认知障碍患者的脑白质高信号轨迹。
White Matter Hyperintensity Trajectories in Patients With Progressive and Stable Mild Cognitive Impairment.
机构信息
From the Department of Psychiatry (F.K., Y.Z., M.D.), McGill University; Douglas Mental Health University Institute (F.K., Y.Z., M.D.); Department of Neurology and Neurosurgery (C.M., J.M.), Faculty of Medicine, and McConnell Brain Imaging Centre (C.M.), Montreal Neurological Institute, McGill University; and Department of Anatomy (J.M.), University of Quebec in Trois-Rivières, Canada.
出版信息
Neurology. 2023 Aug 22;101(8):e815-e824. doi: 10.1212/WNL.0000000000207514. Epub 2023 Jul 5.
BACKGROUND AND OBJECTIVES
White matter hyperintensities (WMH) are pathologic brain changes that are associated with increased age and cognitive decline. However, the association of WMH burden with amyloid positivity and conversion to dementia in people with mild cognitive impairment (MCI) is unclear. The aim of this study was to expand on this research by examining whether change in WMH burden over time differs in amyloid-negative (Aβ-) and amyloid-positive (Aβ+) people with MCI who either remain stable or convert to dementia. To examine this question, we compared regional WMH burden in 4 groups: Aβ+ progressor, Aβ- progressor, Aβ+ stable, and Aβ- stable.
METHODS
Participants with MCI from the Alzheimer Disease Neuroimaging Initiative were included if they had APOE ɛ4 status and if amyloid measures were available to determine amyloid status (i.e., Aβ+, or Aβ-). Participants with a baseline diagnosis of MCI and who had APOE ɛ4 information and amyloid measures were included. An average of 5.7 follow-up time points per participant were included, with a total of 5,054 follow-up time points with a maximum follow-up duration of 13 years. Differences in total and regional WMH burden were examined using linear mixed-effects models.
RESULTS
A total of 820 participants (55-90 years of age) were included in the study (Aβ+ progressor, n = 239; Aβ- progressor, n = 22; Aβ+ stable, n = 343; Aβ- stable, n = 216). People who were Aβ- stable exhibited reduced baseline WMH compared with Aβ+ progressors and people who were Aβ+ stable at all regions of interest (β belongs to 0.20-0.33, CI belongs to 0.03-0.49, < 0.02), except deep WMH. When examining longitudinal results, compared with people who were Aβ- stable, all groups had steeper accumulation in WMH burden with Aβ+ progressors (β belongs to -0.03 to 0.06, CI belongs to -0.05 to 0.09, < 0.01) having the largest increase (i.e., largest increase in WMH accumulation over time).
DISCUSSION
These results indicate that WMH accumulation contributes to conversion to dementia in older adults with MCI who are Aβ+ and Aβ-.
背景与目的
脑白质高信号（WMH）是与年龄增长和认知能力下降相关的病理性脑改变。然而，WMH 负担与轻度认知障碍（MCI）患者中淀粉样蛋白阳性和向痴呆转化的相关性尚不清楚。本研究的目的是通过检查在 MCI 患者中，无论是否稳定或转化为痴呆，淀粉样蛋白阴性（Aβ-）和淀粉样蛋白阳性（Aβ+）患者的 WMH 负担随时间的变化是否不同，来扩展这一研究。为了检验这一问题，我们比较了 4 组的区域 WMH 负担：Aβ+进展者、Aβ-进展者、Aβ+稳定者和 Aβ-稳定者。
方法
如果参与者具有 APOE ɛ4 状态且有淀粉样蛋白测量值可用于确定淀粉样蛋白状态（即 Aβ+或 Aβ-），则将来自阿尔茨海默病神经影像学倡议的 MCI 参与者纳入研究。纳入了基线诊断为 MCI 且具有 APOE ɛ4 信息和淀粉样蛋白测量值的参与者。每位参与者平均有 5.7 个随访时间点，共 5054 个随访时间点，最长随访时间为 13 年。使用线性混合效应模型检查总 WMH 负担和区域 WMH 负担的差异。
结果
共纳入 820 名参与者（55-90 岁）进行研究（Aβ+进展者，n=239；Aβ-进展者，n=22；Aβ+稳定者，n=343；Aβ-稳定者，n=216）。与 Aβ+进展者和所有感兴趣区域（ROI）的 Aβ+稳定者相比，Aβ-稳定者的基线 WMH 较低（β 值为 0.20-0.33，CI 值为 0.03-0.49， < 0.02），但深部 WMH 除外。在检查纵向结果时，与 Aβ-稳定者相比，所有组的 WMH 负担都有更陡峭的积累，而 Aβ+进展者（β 值为-0.03 至 0.06，CI 值为-0.05 至 0.09， < 0.01）的积累量最大（即随时间推移 WMH 积累量的最大增加）。
讨论
这些结果表明，WMH 积累会导致 Aβ+和 Aβ-的老年 MCI 患者向痴呆转化。
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