Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy.
Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy.
J Neurol Sci. 2024 Sep 15;464:123163. doi: 10.1016/j.jns.2024.123163. Epub 2024 Aug 6.
Vascular mild cognitive impairment (VMCI) is a transitional condition that may evolve into Vascular Dementia(VaD). Hippocampal volume (HV) is suggested as an early marker for VaD, the role of white matter lesions (WMLs) in neurodegeneration remains debated.
Evaluate HV and WMLs as predictive markers of VaD in VMCI patients by assessing: (i)baseline differences in HV and WMLs between converters to VaD and non-converters, (ii) predictive power of HV and WMLs for VaD, (iii) associations between HV, WMLs, and cognitive decline, (iv)the role of WMLs on HV.
This longitudinal multicenter study included 110 VMCI subjects (mean age:74.33 ± 6.63 years, 60males/50females) from the VMCI-Tuscany Study database. Subjects underwent brain MRI and cognitive testing, with 2-year follow-up data on VaD progression. HV and WMLs were semi-automatically segmented and measured. ANCOVA assessed group differences, while linear and logistic regression models evaluated predictive power.
After 2 years, 32/110 VMCI patients progressed to VaD. Converting patients had lower HV(p = 0.015) and higher lesion volumes in the posterior thalamic radiation (p = 0.046), splenium of the corpus callosum (p = 0.016), cingulate gyrus (p = 0.041), and cingulum hippocampus(p = 0.038). HV alone did not fully explain progression (p = 0.059), but combined with WMLs volume, the model was significant (p = 0.035). The best prediction model (p = 0.001) included total HV (p = 0.004) and total WMLs volume of the posterior thalamic radiation (p = 0.005) and cingulate gyrus (p = 0.005), achieving 80% precision, 81% specificity, and 74% sensitivity. Lower HV were linked to poorer performance on the Rey Auditory-Verbal Learning Test delayed recall (RAVLT) and Mini Mental State Examination (MMSE).
HV and WMLs are significant predictors of progression from VMCI to VaD. Lower HV correlate with worse cognitive performance on RAVLT and MMSE tests.
血管性轻度认知障碍（VMCI）是一种可能发展为血管性痴呆（VaD）的过渡状态。海马体积（HV）被认为是 VaD 的早期标志物，而白质病变（WMLs）在神经退行性变中的作用仍存在争议。
通过评估：（i）VMCI 患者中向 VaD 转化者与未转化者之间 HV 和 WMLs 的基线差异，（ii）HV 和 WMLs 对 VaD 的预测能力，（iii）HV、WMLs 与认知衰退的相关性，（iv）WMLs 对 HV 的作用，来评估 HV 和 WMLs 作为 VMCI 患者 VaD 的预测标志物。
本项纵向多中心研究纳入了 110 例来自 VMCI-Tuscany 研究数据库的 VMCI 患者（平均年龄：74.33±6.63 岁，60 名男性/50 名女性）。对受试者进行了脑部 MRI 和认知测试，并对 VaD 进展情况进行了为期 2 年的随访。采用半自动方法对 HV 和 WMLs 进行分割和测量。方差分析（ANCOVA）评估组间差异，线性和逻辑回归模型评估预测能力。
2 年后，110 例 VMCI 患者中有 32 例进展为 VaD。转化组患者 HV 较低（p=0.015），丘脑后辐射（p=0.046）、胼胝体体部（p=0.016）、扣带回（p=0.041）和海马伞（p=0.038）的病变体积较高。HV 单独并不能完全解释进展（p=0.059），但与 WMLs 体积相结合，该模型具有显著性（p=0.035）。最佳预测模型（p=0.001）包括总 HV（p=0.004）和丘脑后辐射（p=0.005）和扣带回（p=0.005）的总 WMLs 体积，其准确率为 80%，特异性为 81%，灵敏度为 74%。较低的 HV 与 Rey 听觉言语学习测试延迟回忆（RAVLT）和简易精神状态检查（MMSE）的表现较差相关。
HV 和 WMLs 是从 VMCI 向 VaD 进展的重要预测因子。较低的 HV 与 RAVLT 和 MMSE 测试认知表现较差相关。
