脑小血管病影像学标志物与认知功能障碍相关性分析:基于上海社区老年人队列

The analysis of association between imaging biomarkers of cerebral small vessel disease and cognitive impairment: a Shanghai elderly community-based cohort

目的探讨我国社区老年人脑小血管病影像学标志物与总体认知功能和不同认知域的相关性。方法 2016年8月至2019年10月招募上海市静安区、闵行区、青浦区共933例社区健康老年人,头部MRI评估脑小血管病影像学标志物,包括腔隙性梗死、脑白质高信号、脑微出血、扩大的血管周围间隙和总评分;蒙特利尔认知评价量表(MoCA)评估总体认知功能,听觉词语学习测验(AVLT)评估记忆力,连线测验(TMT)评估执行功能,搭火柴测验(ST)评估视空间能力,改编的常见物体分类测验(COST)评估语言功能。Spearman秩相关分析和偏相关分析探讨脑小血管病影像学标志物与总体认知功能和各认知域的相关性,多因素线性逐步回归分析验证二者的线性数量关系。结果最终863例完成头部MRI检查和认知功能评估。相关分析显示,腔隙性梗死与TMT评分呈正相关(r=0.072,P=0.038),脑深部白质高信号与ST评分呈正相关(r=0.105,P=0.047),脑室旁白质高信号(r=-0.111,P=0.001)、脑微出血(r=-0.088,P=0.015)和总评分(r=-0.087,P=0.015)与MoCA评分呈负相关。进一步行多因素线性逐步回归分析,校正性别、年龄、受教育程度、高血压、糖尿病、高脂血症、吸烟史因素后,脑室旁白质高信号(标准化偏回归系数=-0.088,FDR校正后P=0.020)和脑微出血(标准化偏回归系数=-0.078,FDR校正后P=0.040)与MoCA评分存在线性回归关系。结论在我国社区老年人群中,脑小血管病可能对认知功能的早期损害有潜在作用,脑室旁白质高信号和任意部位脑微出血是总体认知功能障碍的早期影像学标志物。

Objective To investigate the associations between imaging markers of cerebral small vessel disease(CSVD) and global cognition and cognitive domains in the community elderly people.Methods From August 2016 to October 2019,933 healthy community elderly subjects were enrolled from three districts in Shanghai.We used MRI to assess imaging markers of CSVD,including lacunar infarct(LACI),white matter hyperintensity(WMH),cerebral microbleeds(CMBs),enlarged perivascular space(EPVS) and total CSVD score.These subjects underwent Montreal Cognitive Assessment(MoCA) to assess global cognition,Auditory Verbal Learning Test(AVLT) to assess memory function,Trial Making Test(TMT) to assess executive function,Stick Test(ST) to assess visuospatial function,adapted Common Objects Sorting Test(COST) to assess language function.We performed Spearman rank correlation and partial correlation analyses to investigate the association between imaging markers and cognition,and multiple linear regression analysis to validate the relationships.Results A total of 863 subjects underwent head MRI and cognitive assessment.In Spearman rank correlation analysis,LACI(r_(s)=-0.076,P=0.025) and periventricular WMH(r_(s)=-0.070,P=0.044) was correlated with MoCA.LACI(r_(s)=-0.086,P=0.022),basal ganglia EPVS(r_(s)=-0.078,P=0.038) and total CSVD score(r_(s)=-0.090,P=0.023) were correlated with AVLT.LACI was correlated with TMT(r_(s)=0.099,P=0.004).Periventricular WMH(r_(s)=-0.113,P=0.029) and strictly lobar CMB(r_(s)=-0.107,P=0.041) were correlated with ST.Centrum semiovale EPVS was correlated with COST(r_(s)=-0.150,P=0.004).In partial correlation analysis,LACI was associated with TMT(r=0.072,P=0.038).Deep WMH was associated with ST(r=0.105,P=0.047).Periventricular WMH(r=-0.111,P=0.001),CMBs(r=-0.088,P=0.015) and total CSVD score(r=-0.087,P=0.015)were associated with MoCA.In multiple linear regression analysis,after adjusting sex,age,education,hypertension,diabetes mellitus,hyperlipidemia and smoking history factors,periventricular WMH(β_(scandardized)=-0.088,P_(FDR)=0.020) and CMBs at any position(β_(standardized)=-0.078,P_(FDR)=0.040) were independently correlated with MoCA.Conclusions In the elderly community population in China,CSVD may already have an impact on cognition.Periventricular WMH and CMBs are early imaging markers for CSVD-related global cognitive impairment.