Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus Graduate School of Medicine, Nishihara-cho, Okinawa, Japan.
Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
J Alzheimers Dis. 2024;101(2):627-636. doi: 10.3233/JAD-240589.
Recent studies have demonstrated an association between pulse wave velocity (PWV), cerebral small vessel disease (SVD), and cognitive impairment such as Alzheimer's disease. However, the association between brachial-ankle PWV and enlarged perivascular spaces (EPVS), one component of cerebral SVD remains controversial.
To investigate the relationship between brachial-ankle PWV and EPVS severity in participants without dementia.
We performed a cross-sectional study of data of 74 participants from sub-analysis of ongoing research. We assessed cognitive function, brachial-ankle PWV, and brain magnetic resonance imaging (MRI) features. Using brain MRI, EPVS were separately assessed as basal ganglia (BG)-EPVS or centrum semiovale (CSO)-EPVS on the basis of their location. The relationship between EPVS severity and brachial-ankle PWV was evaluated using multivariable ordinal logistic regression analyses.
We analyzed 74 participants (women: 47%, mean age: 73 years, mild cognitive impairment [MCI]: 74%). Compared with participants with normal cognition, those with MCI were more likely to have both severe BG-EPVS and severe CSO-EPVS. In multivariable analyses, high brachial-ankle PWV and age were independently associated with BG-EPVS severity (odds ratio [95% confidence interval]: 1.19 [1.02-1.38], 1.09 [1.01-1.17], respectively), whereas only age was independently associated with CSO-EPVS severity. A causal mediation analysis under a counterfactual approach revealed a significant pure natural indirect effect of brachial-ankle PWV on MCI that was mediated by BG-EPVS (estimate: 1.04, 95% CI: 1.01-1.12, p = 0.006).
Brachial-ankle PWV was associated with BG-EPVS severity. High PWV may cause cerebrovascular pulsatility, which accelerates BG-EPVS and may worsen cognitive impairment.
最近的研究表明，脉搏波速度（PWV）、脑小血管疾病（SVD）与认知障碍（如阿尔茨海默病）之间存在关联。然而，臂踝 PWV 与脑 SVD 的一个组成部分——血管周围间隙扩大（EPVS）之间的关联仍存在争议。
探讨无痴呆症参与者臂踝 PWV 与 EPVS 严重程度的关系。
我们对正在进行的研究的子分析中 74 名参与者的数据进行了横断面研究。我们评估了认知功能、臂踝 PWV 和脑磁共振成像（MRI）特征。根据 EPVS 的位置，脑 MRI 分别评估基底节（BG）-EPVS 或脑半卵圆中心（CSO）-EPVS。使用多变量有序逻辑回归分析评估 EPVS 严重程度与臂踝 PWV 之间的关系。
我们分析了 74 名参与者（女性占 47%，平均年龄为 73 岁，轻度认知障碍 [MCI] 占 74%）。与认知正常的参与者相比，MCI 患者更有可能同时出现严重的 BG-EPVS 和严重的 CSO-EPVS。多变量分析显示，高臂踝 PWV 和年龄与 BG-EPVS 严重程度独立相关（比值比 [95%置信区间]：1.19 [1.02-1.38]，1.09 [1.01-1.17]），而只有年龄与 CSO-EPVS 严重程度独立相关。在反事实方法下的因果中介分析显示，臂踝 PWV 对 MCI 的纯自然间接效应具有显著意义，该效应由 BG-EPVS 介导（估计值：1.04，95%置信区间：1.01-1.12，p=0.006）。
臂踝 PWV 与 BG-EPVS 严重程度相关。高 PWV 可能导致脑血管搏动性增加，加速 BG-EPVS，并可能导致认知障碍恶化。
