高龄脑小血管病患者重度脑白质损害和认知功能下降风险的相关分析

Severe cerebral white matter lesions predict severe cognitive decline in elderly patients with cerebral small vessel disease

目的脑小血管病被认为是导致高龄人群血管性痴呆的重要原因。文中探讨高龄脑小血管病患者重度脑白质损害和认知功能下降风险的关系。方法选择2009年1月至2010年12月期间在南京军区南京总医院住院的80岁以上男性脑小血管病患者307例,通过影像学检查和评定量表对脑白质损害分级,在随访中对研究对象进行认知功能测定,分析起始点重度脑白质损害和随访中严重认知功能障碍或痴呆的发生间的相关性。结果基线时严重脑白质损害在研究对象中达26.4%;年龄、微出血、腔隙性梗死与脑白质损害严重程度有关(P<0.01);在随访过程中,出现痴呆或认知功能严重下降的患者有46名;多因素分析显示经过平均3.2年随访,起始点存在严重脑白质损害的患者发生痴呆或严重认知功能下降的风险高于无脑白质损害(RR=8.2,P<0.01)或轻中度脑白质损害的患者(RR=1.7,P<0.01)。结论重度脑白质损害是高龄脑小血管病患者发生严重认知功能下降的重要预测因素。

Objective Cerebral small vessel disease （ CSVD ） is considered as an important cause of vascular dementia in elderly people .The aim of this study was to explore the correlation between severe white matter lesions and severe cognitive decline in elderly CSVD patients. Methods We performed MRI scanning for 307 hospitalized CSVD patients aged over 80 （83.3 ＆#177;2.7） years and assessed the white matter lesions with a rating scale .During the follow-up, we evaluated the cognitive function of the patients and analyzed the correlation of severe white matter lesions with the incidence of severe cognitive deterioration or dementia . Results Se-vere white matter lesions at the baseline accounted for 26 .4%, and the severity was significantly correlated with age , microbleeding and lacunar infarct （P＆lt;0.01）.Follow-up visits revealed dementia or severe cognitive decline in 46 of the patients.A mean follow-up of 3.2 years showed that the incidence of severe cognitive deterioration was higher markedly in the patients with severe white matter le -sions at admission than in those without （RR=8.2, P＆lt;0.01） and those with mild-moderate white matter lesions （RR=1.7, P＆lt;0.01）. Conclusion Severe white matter lesions are an important predictor of dementia and cognitive decline in patients with cere -bral small vessel disease .