Kitagawa Kazuo, Toi Sono, Yoshizawa Hiroshi, Todo Kenichi
Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
Departemnt of Neurology, Suita Municipal Hospital, Suita, Japan.
Hypertens Res. 2025 Jun 4. doi: 10.1038/s41440-025-02242-8.
Hypertension is the most significant risk factor of cerebral small vessel disease (SVD). SVD raises the likelihood of poor functional outcomes in independent older adults, though the underlying causes remains uncertain. This study aimed to investigate the link between incident events and poor functional outcomes in individuals with SVD. In this post hoc analysis, data were sourced from a Japanese observational registry, including 1011 patients with cerebral vessel disease evident on magnetic resonance imaging and vascular risk factors. Follow-up continued until March 2023. After excluding participants with suspected dementia, Modified Rankin Scale (mRS) scores of 2 or more, or missing Mini-Mental State Examination results, 859 patients were analyzed. SVD was defined as moderate to severe white matter hyperintensity (WMH) and/or the presence of lacune. The study's outcome was a poor functional status defined as a mRS score ≥3 at the last visit. Over a median follow-up of 4.6 years, 50 patients died, and 85 experienced poor functional outcomes. WMH or lacune were associated with an increased risk of all-cause mortality and poor functional outcomes. Key causes of death included cancer, heart disease, pneumonia and senility, while stroke, dementia and fall-related injuries also elevated the risk of poor functional outcomes. WMH or lacune specifically heightened the risk of stroke and dementia. In conclusion, SVD elevates the risk of poor functional outcomes primarily via incident stroke and dementia. To maintain independence in daily activities among elderly individuals, targeted prevention of stroke and dementia is crucial in patients with SVD. Proposed mechanism linking small vessel disease, typically white matter hyperintensity/lacune, with poor functional outcome. Seven incident events, neoplasm, heart disease, stroke, dementia, falls, pneumonia, and motor function impairment, potentially related to poor functional outcomes. In elderly patients, SVD significantly increases the risk of stroke, and moderately raises the risk of dementia, pneumonia, and motor impairment which may be related to senility. This relationship helps explain why patients with SVD are more likely to experience poor functional outcomes compared to those without SVD.
高血压是脑小血管病（SVD）最重要的危险因素。SVD增加了独立老年人功能预后不良的可能性，但其潜在原因仍不确定。本研究旨在调查SVD患者中偶发事件与功能预后不良之间的联系。在这项事后分析中，数据来源于一个日本观察性登记处，包括1011例磁共振成像显示有脑血管疾病且伴有血管危险因素的患者。随访持续到2023年3月。在排除疑似痴呆、改良Rankin量表（mRS）评分≥2或简易精神状态检查结果缺失的参与者后，对859例患者进行了分析。SVD被定义为中度至重度白质高信号（WMH）和/或存在腔隙。该研究的结局是功能状态不佳，定义为最后一次随访时mRS评分≥3。在中位随访4.6年期间，50例患者死亡，85例出现功能预后不良。WMH或腔隙与全因死亡率增加和功能预后不良相关。主要死因包括癌症、心脏病、肺炎和衰老，而中风、痴呆和跌倒相关损伤也增加了功能预后不良的风险。WMH或腔隙尤其增加了中风和痴呆的风险。总之，SVD主要通过偶发中风和痴呆增加功能预后不良的风险。为了维持老年人日常生活中的独立性，针对性预防中风和痴呆对SVD患者至关重要。提出了将小血管疾病（通常为白质高信号/腔隙）与功能预后不良联系起来的机制。七种偶发事件，即肿瘤、心脏病、中风痴呆、跌倒、肺炎和运动功能损害，可能与功能预后不良有关。在老年患者中，SVD显著增加中风风险，并适度增加痴呆、肺炎和可能与衰老相关的运动功能损害风险。这种关系有助于解释为什么与无SVD的患者相比，SVD患者更有可能出现功能预后不良。
