Skoog I, Palmertz B, Andreasson L A
Department of Psychiatry, University of Gothenburg, Sahlgren's Hospital, Sweden.
J Geriatr Psychiatry Neurol. 1994 Jul-Sep;7(3):169-75. doi: 10.1177/089198879400700308.
The prevalence of white-matter lesions on computed tomography was studied in a representative sample of 85-year-olds living in Gothenburg, Sweden. The study included a psychiatric examination, interview of a close informant, neuropsychological examination, physical examination, comprehensive laboratory tests, electrocardiogram, chest x-ray, computed tomography scan of the head, and cerebrospinal fluid analysis. The diagnoses of dementia and other mental disorders were made according to DSM-III-R criteria. The prevalence of white-matter lesions in demented subjects was 68.9%, and in nondemented, 33.8%. Their prevalence was not increased in any mental disorder other than dementia. All severities of dementia and the subtypes, Alzheimer's disease, vascular dementia, and other types of dementia, had a significantly higher prevalence of white-matter lesions than did nondemented subjects. The risk for dementia, but not its severity, increased with the severity of these lesions. A stepwise logistic regression analysis showed that both white-matter lesions and infarcts on computed tomography contributed independently to dementia. White-matter changes may be a contributing cause of dementia in the oldest old, or may represent a disease entity of its own. They are important to recognize since they may be potentially preventable, or even treatable.
在瑞典哥德堡生活的85岁老人的代表性样本中，研究了计算机断层扫描上白质病变的患病率。该研究包括精神病学检查、对亲密知情者的访谈、神经心理学检查、体格检查、全面的实验室检查、心电图、胸部X光、头部计算机断层扫描以及脑脊液分析。根据《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）标准做出痴呆和其他精神障碍的诊断。痴呆患者中白质病变的患病率为68.9%，非痴呆患者中为33.8%。除痴呆外，在任何其他精神障碍中其患病率均未增加。所有严重程度的痴呆及其亚型，即阿尔茨海默病、血管性痴呆和其他类型的痴呆，白质病变的患病率均显著高于非痴呆患者。痴呆的风险而非其严重程度随着这些病变的严重程度增加。逐步逻辑回归分析表明，计算机断层扫描上的白质病变和梗死均独立导致痴呆。白质变化可能是最年长者痴呆的一个促成原因，或者可能代表一种自身的疾病实体。认识到它们很重要，因为它们可能是潜在可预防的，甚至是可治疗的。
