Tsai Ya-Chin, Tsai Hsin-Hsi, Liu Chia-Ju, Lin Sheng-Sian, Chen Ya-Fang, Jeng Jiann-Shing, Tsai Li-Kai, Yen Ruoh-Fang
Department of Nuclear Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan.
Brain Behav. 2023 Oct;13(10):e3189. doi: 10.1002/brb3.3189. Epub 2023 Aug 2.
To investigate the association between cerebral amyloid deposition and long-term cognitive outcomes in patients with hemorrhagic small vessel disease (SVD) and survivors of intracerebral hemorrhage (ICH).
Patients experiencing an ICH without overt dementia were prospectively recruited (n = 68) for brain MRI and Pittsburgh compound B (PiB) positron emission tomography scans at baseline. Cognitive function was assessed using the mini-mental status examination (MMSE) and clinical dementia rating after an overall median follow-up of 3.8 years. A positive amyloid scan was defined as a global PiB standardized uptake value ratio >1.2. Associations between follow-up cognitive outcomes and neuroimaging markers were explored using multivariable Cox regression models.
PiB(+) patients were older (72.1 ± 7.8 vs. 59.9 ± 11.7, p = .002) and more frequently had cerebral amyloid angiopathy (CAA) (63.6% vs. 15.8%, p = .002) than PiB(-) patients. PiB(+) was associated with a higher risk of dementia conversion (32.9 vs. 4.0 per 100-person-years, hazard ratio [HR] = 15.7 [3.0-80.7], p = .001) and MMSE score decline (58.8 vs. 9.9 per 100-person-years, HR = 6.2 [1.9-20.0], p = .002). In the non-CAA subgroup (n = 52), PiB(+) remained an independent predictor of dementia conversion, p = .04). In the Cox models, PiB(+) was an independent predictor of dementia conversion (HR = 15.8 [2.6-95.4], p = .003) and MMSE score decline (HR = 5.7 [1.6-20.3], p = .008) after adjusting for confounders.
Cerebral amyloid deposition potentially contributes to long-term cognitive decline in SVD-related ICH.
探讨出血性小血管病（SVD）患者及脑出血（ICH）幸存者脑淀粉样蛋白沉积与长期认知结局之间的关联。
前瞻性招募68例无明显痴呆的ICH患者，在基线时进行脑部MRI和匹兹堡化合物B（PiB）正电子发射断层扫描。在总体中位随访3.8年后，使用简易精神状态检查表（MMSE）和临床痴呆评定量表评估认知功能。淀粉样蛋白扫描阳性定义为全球PiB标准化摄取值比率>1.2。使用多变量Cox回归模型探讨随访认知结局与神经影像标志物之间的关联。
与PiB（-）患者相比，PiB（+）患者年龄更大（72.1±7.8岁 vs. 59.9±11.7岁，p = 0.002），脑淀粉样血管病（CAA）的发生率更高（63.6% vs. 15.8%，p = 0.002）。PiB（+）与痴呆转化风险较高相关（每100人年32.9例 vs. 4.0例，风险比[HR]=15.7[3.0 - 80.7]，p = 0.001）以及MMSE评分下降相关（每100人年58.8例 vs. 9.9例，HR = 6.2[1.9 - 20.0]，p = 0.002）。在非CAA亚组（n = 52）中，PiB（+）仍然是痴呆转化的独立预测因素，p = 0.04）。在Cox模型中，调整混杂因素后，PiB（+）是痴呆转化（HR = 15.8[2.6 - 95.4]，p = 0.003）和MMSE评分下降（HR = 5.7[1.6 - 20.3]，p = 0.008）的独立预测因素。
脑淀粉样蛋白沉积可能导致SVD相关ICH的长期认知衰退。
