Yohe Emile Omba, Alonso Alvaro, Drane Daniel L, Patel Saranya Sundaram, Schwinne Megan, Epenge Emmanuel, Gikelekele Guy, Herve Esambo, Kavugho Immaculee, Tshengele Nathan, Mampunza Samuel, Mananga Lelo, Zhao Liping, Qiu Deqiang, Stringer Anthony, Saindane Amit M, Ikanga Jean
Emory University, Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, 30322, USA.
Emory University School of Medicine, Departments of Neurology and Pediatrics, Atlanta, Georgia 30322, USA.
medRxiv. 2024 Sep 4:2024.09.03.24313022. doi: 10.1101/2024.09.03.24313022.
White matter hyperintensities (WMHs) are strongly linked to cardiovascular risk factors and other health conditions such as Alzheimer's disease. However, there is a dearth of research on this topic in low-income countries and underserved populations, especially in the Democratic Republic of Congo (DRC) where the population is aging rapidly with increasing cardiovascular risk factors and dementia-related diseases. This study evaluates health factors associated with WMH in the elderly Sub-Saharan Africa (SSA), specifically Congolese adults.
In a cross-sectional study of 77 people from the DRC, participants underwent neuroimaging to analyze WMH volume and completed clinical evaluation, laboratory-based blood exams, self-reported questionnaires, and interviews. A simple linear regression model was conducted to test the association between WMH and potential predictors (neurological status, age, sex, hypertension, diabetes, tobacco abuse, stroke, high cholesterol, cardiovascular medication, and alcohol abuse). Stepwise selection and backward elimination analyses were performed to obtain the final model. Finally, a multiple linear regression model was conducted to assess the association between WMH and variables retained in the final model (neurological status, sex, and age).
Of the 77 individuals, 47 (61%) had dementia, 40 (52.6%) were males, and the mean age was 73 years (± 8.0 years standard deviation). In simple linear regression models, WMH was significantly associated with dementia (expβ1=1.75, 95% CI=1.14 - 2.71, p-value=0.01) though it had a weak association with age (expβ1=1.03, 95% CI=1.00 - 1.05, p-value=0.05) and sex (male) (expβ1=0.66, 95% CI=0.43 - 1.01, p-value=0.05). In multiple linear regression models, WMH was statistically significantly associated with dementia (expβ1=1.97, 95% CI=1.31 - 2.95, p-value =0.001), male sex (expβ2=0.54, 95% CI=0.36 - 0.80, p-value=0.003), and age (expβ3=1.03, 95% CI=1.00 - 1.06, p-value=0.03). However, WMH was not significantly associated with common cardiovascular risk factors, such as high blood pressure, diabetes, tobacco use, obesity, and high cholesterol levels.
WMH is significantly associated with neurological status, sex, and age in the Congolese population. Understanding these predictors may improve our ability to diagnose, assess, and develop preventative treatments for white matter disease in SSA/DRC populations, where neuroimaging is difficult to obtain.
脑白质高信号（WMHs）与心血管危险因素及其他健康状况（如阿尔茨海默病）密切相关。然而，低收入国家及服务不足人群在这一主题上的研究匮乏，尤其是在刚果民主共和国（DRC），该国人口老龄化迅速，心血管危险因素及与痴呆相关疾病不断增加。本研究评估撒哈拉以南非洲（SSA）老年人，特别是刚果成年人中与WMH相关的健康因素。
在一项对77名刚果民主共和国人的横断面研究中，参与者接受神经影像学检查以分析WMH体积，并完成临床评估、实验室血液检查、自我报告问卷及访谈。采用简单线性回归模型检验WMH与潜在预测因素（神经状态、年龄、性别、高血压、糖尿病、烟草滥用、中风、高胆固醇、心血管药物及酒精滥用）之间的关联。进行逐步选择和向后剔除分析以获得最终模型。最后，采用多元线性回归模型评估WMH与最终模型中保留变量（神经状态、性别和年龄）之间的关联。
77名个体中，47名（61%）患有痴呆，40名（52.6%）为男性，平均年龄为73岁（标准差±8.0岁）。在简单线性回归模型中，WMH与痴呆显著相关（expβ1 = 1.75，95%可信区间 = 1.14 - 2.71，p值 = 0.01），尽管其与年龄（expβ1 = 1.03，95%可信区间 = 1.00 - 1.05，p值 = 0.05）及性别（男性）（expβ1 = 0.66，95%可信区间 = 0.43 - 1.01，p值 = 0.05）的关联较弱。在多元线性回归模型中，WMH与痴呆（expβ1 = 1.97，95%可信区间 = 1.31 - 2.95，p值 = 0.001）、男性性别（expβ2 = 0.54，95%可信区间 = 0.36 - 0.80，p值 = 0.003）及年龄（expβ3 = 1.03，95%可信区间 = 1.00 - 1.06，p值 = 0.03）显著相关。然而，WMH与常见心血管危险因素（如高血压、糖尿病、烟草使用、肥胖及高胆固醇水平）无显著关联。
在刚果人群中，WMH与神经状态、性别和年龄显著相关。了解这些预测因素可能提高我们对撒哈拉以南非洲/刚果民主共和国人群中白质疾病的诊断、评估及制定预防治疗措施的能力，在这些地区神经影像学检查难以获得。
