脑白质高信号与中年人群认知表现的关联
Association of the Brain White Matter Hyperintensity with the Cognitive Performance in Middle-Aged Population.
作者信息
Hannawi Yousef, Yanek Lisa R, Kral Brian G, Becker Lewis C, Vaidya Dhananjay, Nyquist Paul A
机构信息
Division of Cerebrovascular Diseases and Neurocritical Care, Department of Neurology, The Ohio State University, Columbus, Ohio, USA.
GeneSTAR Research Program, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
出版信息
Cerebrovasc Dis. 2024 Nov 21:1-8. doi: 10.1159/000542710.
INTRODUCTION
White matter hyperintensity (WMH) is typically classified into periventricular and deep WMH (PVWMH and DWMH) based on its proximity to the ventricles. While WMH volume has been associated with the cognitive performance and decline in patients with cerebral small vessel disease, the relative contributions of PVWMH and DWMH to the cognitive profile of these patients remain unclear. Therefore, we aimed to determine the differences in association of PVWMH and DWMH with a battery of cognitive tests in a group of middle-aged population at risk for cardiovascular disease.
METHODS
Participants in the Genetic Study for Atherosclerosis Risk (GeneSTAR) who had a brain magnetic resonance imaging, a cognitive battery, and were older than 50 years of age were studied. The relative association of PVWMH and DWMH with each of the cognitive measures was tested using multilevel linear regression models adjusting for age, intracranial volume, and cardiovascular risk factors. Adjustment for multiple comparisons was completed by using Benjamini-Hochberg procedure for the primary outcome and q-value of <0.1 was considered significant. Maximal likelihood estimation analysis was used to explore whether age moderated the difference in association of PVWMH and DWMH with the cognitive tests.
RESULTS
A total of 435 participants (age 58.9 ± 6.14 years, 58.38% women, and 39.54% black) were studied. We identified a greater association of PVWMH than DWMH with a worse performance on the grooved peg board test (q-value = 0.06) including the dominant (q-value = 0.098) and nondominant hand (q-value = 0.098) performance as well as the delayed word recall test in its short form (q-value = 0.098). Age did not moderate the differences in the association of PVWMH and DWMH with these cognitive tests.
CONCLUSIONS
Our findings indicate a greater effect of PVWMH than DWHM on manipulative manual dexterity and delayed word recall functions suggesting potential injury of the white matter tracts that are relevant to these function by PVWMH. These findings need to be confirmed in future large prospective studies.
引言
白质高信号（WMH）通常根据其与脑室的距离分为脑室周围白质高信号（PVWMH）和深部白质高信号（DWMH）。虽然WMH体积与脑小血管疾病患者的认知表现和认知衰退有关，但PVWMH和DWMH对这些患者认知特征的相对贡献仍不清楚。因此，我们旨在确定一组有心血管疾病风险的中年人群中，PVWMH和DWMH与一系列认知测试之间关联的差异。
方法
对动脉粥样硬化风险基因研究（GeneSTAR）中年龄超过50岁、进行过脑磁共振成像和认知测试的参与者进行研究。使用多水平线性回归模型测试PVWMH和DWMH与每种认知测量指标的相对关联，并对年龄、颅内体积和心血管危险因素进行调整。通过使用Benjamini-Hochberg程序对主要结局进行多重比较调整，q值<0.1被认为具有统计学意义。使用最大似然估计分析来探讨年龄是否调节了PVWMH和DWMH与认知测试关联的差异。
结果
共研究了435名参与者（年龄58.9±6.14岁，58.38%为女性，39.54%为黑人）。我们发现，PVWMH与沟槽钉板测试（q值=0.06）表现较差的关联比DWMH更强，包括优势手（q值=0.098）和非优势手（q值=0.098）的表现，以及简短形式的延迟单词回忆测试（q值=0.098）。年龄并未调节PVWMH和DWMH与这些认知测试关联的差异。
结论
我们的研究结果表明，PVWMH对操作手动灵活性和延迟单词回忆功能的影响比DWMH更大，这表明PVWMH可能损伤了与这些功能相关的白质束。这些发现需要在未来的大型前瞻性研究中得到证实。
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