脑小血管病磁共振成像总负荷与帕金森病认知障碍的相关性研究

Correlation between total MRI burden in cerebral small vascular disease and cognitive impairment in Parkinson′s Disease

目的帕金森病(PD)伴发脑小血管病(CSVD)可能会加重PD的认知障碍。本研究旨在探讨CSVD总负荷与PD认知功能的关系。方法回顾性比较了165例PD患者的临床和神经影像学特征,所有患者均接受脑部磁共振成像(MRI)检查,并通过假定血管源性的腔隙、白质高信号(WMH)、脑微出血(CMB)和血管周围间隙扩大(EPVS)评估其CSVD总负荷。通过进行蒙特利尔认知评价量表(MoCA)来评估认知功能,将患者分为帕金森病伴轻度认知障碍(PD-MCI)组和帕金森病伴痴呆(PDD)组。运用多变量二元Logistic回归模型确定认知功能下降的独立危险因素。采用受试者工作特征曲线(ROC)分析方法量化腔隙、CSVD总负荷在区分PD-MCI和PDD的准确性。结果与PD-MCI患者相比,PDD患者的脑室周围高信号(PVH)、深部白质高信号(DWMH)、腔隙、基底节区血管周围间隙扩大(BG-EPVS)以及CSVD总负荷显著升高,且差异有统计学意义。多变量二元logistic回归显示,腔隙[OR值(95%CI)=2.418(1.088,5.371),P=0.030]和CSVD总负荷[OR值(95%CI)=1.572(1.138,2.171),P=0.006]与PD患者认知能力下降独立相关。此外,ROC曲线结果证实腔隙及CSVD总负荷在区分PD-MCI和PDD方面具有良好的准确性。结论CSVD总负荷与PD患者的认知障碍密切相关。腔隙及CSVD总负荷可以作为预测PD患者认知功能减退的关键指标。

Objective Parkinson′s disease(PD)combined with cerebral small vessel disease(CSVD)may aggravate cognitive impairment in PD.This study aimed to investigate the relationship between the total burden of CSVD and cognitive function in PD.Methods This retrospective study compared the clinical and neuroimaging features of 165 PD patients,all of whom underwent MRI of the brain and assessed total CSVD burden by presumed vascular origin lacune,white matter hyperintensity(WMH),cerebral microbleed(CMB),and the enlarged perivascular space(EPVS).Cognitive function was assessed by performing the Montreal Cognitive Evaluation Scale(MoCA)in patients,who were divided into PD with mild cognitive impairment(PD-MCI)and PD with dementia(PDD)groups.Multivariate binary Logistic regression models were used to identify independent risk factors for cognitive decline.Operating characteristic curve(ROC)analysis was used to quantify the accuracy of the lacune and the CSVD total load in distinguishing PD-MCI from PDD.Results Patients with PDD had significantly greater periventricular white matter hyperintensity(PVH),lacune,deep white matter hyperintensity(DWMH),basal perivascular space enlargement(BG-EPVS),and CSVD scores than patients with PD-MCI.Multivariate binary logistic regression showed that lacune[OR(95%CI)=2.418(1.088,5.371),P=0.030]and total CSVD burden[OR(95%CI)=1.572(1.138,2.171),P=0.006]were independently associated with cognitive decline in PD patients.Furthermore,the ROC curve results confirmed that lacune and total CSVD load had good accuracy in distinguishing PD-MCI and PDD.Conclusion The overall burden of CSVD exhibits a strong association with cognitive impairment among patients with PD.The lacune and total burden of CSVD can be used as a key indicator to predict cognitive decline in PD patients.