Kitagawa Kazuo, Toi Sono, Hosoya Megumi, Seki Misa, Yamagishi Sae, Hoshino Takao, Yoshizawa Hiroshi
Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
Department of Neurology, Suita Municipal Hospital, Suita, Japan.
J Alzheimers Dis. 2024;101(3):751-760. doi: 10.3233/JAD-240166.
Total small vessel disease (SVD) score is used to measure the burden of SVD.
This study aimed to clarify the predictive value of total SVD score for incident dementia and functional outcomes in independent outpatients with vascular risk factors.
We derived data from a Japanese cohort in which patients underwent magnetic resonance imaging and cognitive examinations. They were followed up until March 2023. The primary outcomes was dementia. Secondary outcome was functional outcomes. We measured a modified Rankin scale (mRS) score at the last visit and defined poor functional outcomes as mRS score ≥3.
After excluding those with a mRS score ≥2, Mini-Mental State Examination score in Japanese version < 24, and missing T2* images, 692 patients were included. During a median follow-up period of 4.6 years, dementia occurred in 31 patients. In multivariate analysis, the score 4 group showed a significantly higher risk of incident dementia than the score 0-3 groups (adjusted hazard ratio, 6.25; 95% CI, 1.83-21.40, p = 0.003). The total SVD score was also independently related to poor functional outcome.
The total SVD score of 4, and ≥1 could predict dementia and poor functional outcomes, respectively. Our results suggest intensive management of patients with SVD to prevent dementia and to maintain independent activities of daily living.
全脑小血管病（SVD）评分用于衡量SVD的负担。
本研究旨在阐明全脑SVD评分对有血管危险因素的独立门诊患者发生痴呆和功能结局的预测价值。
我们从一个日本队列中获取数据，该队列中的患者接受了磁共振成像和认知检查。对他们进行随访直至2023年3月。主要结局是痴呆。次要结局是功能结局。我们在最后一次随访时测量改良Rankin量表（mRS）评分，并将功能结局差定义为mRS评分≥3。
排除mRS评分≥2、日语版简易精神状态检查表评分<24以及缺失T2*图像的患者后，纳入692例患者。在中位随访期4.6年期间，31例患者发生痴呆。在多变量分析中，评分4组发生痴呆的风险显著高于评分0 - 3组（调整后风险比，6.25；95%置信区间，1.83 - 21.40，p = 0.003）。全脑SVD评分也与功能结局差独立相关。
全脑SVD评分4分及≥1分分别可预测痴呆和功能结局差。我们的结果提示对SVD患者进行强化管理以预防痴呆并维持日常生活的独立活动能力。
