NEUROLOGY:卒中后1年白质高信号体积与认知相关

2022-04-09 影像小生 MedSci原创

卒中 1 年后的WMH 体积与同时期的认知评分密切相关。卒中后认知和独立性的共同纵向下降是痴呆诊断的核心,与 WMH 体积增加有关。

脑小血管(Cerebral small vessel disease, SVD)是脑卒中患者的常见疾病,是脑卒中和血管性痴呆的常见病因。白质高强度(WMH)SVD的一个关键特征,已被证明在卒中、认知受损个体、接受神经或认知症状调查的老年社区居民和健康成年人(平均年龄63)中减少或增加。卒中时白质高信号 (WMH) 的严重程度与卒中后痴呆和依赖性有关。然而,卒中后 WMH 可减少或增加;认知衰退的预测不准确;尽管具有临床重要性,但很少有数据评估卒中后 WMH 变化、认知和功能之间的纵向相互关系。目前尚不清楚SVD病变改变的时间与卒中和痴呆的临床发展之间的关系。

Una Clancy等在NEUROLOGY杂志发表题为Impact of Small Vessel Disease Progression on Long-term Cognitive and Functional Changes After Stroke的研究文章,确定脑卒中后WMH与认知能力和mRS评分在不同时间点是否存在相关性;关联是否因个体内部轨迹而异;纵向WMH体积变化是否与认知和mRS变化相关,这是主要的共变终点;以及是否有任何关联更强烈地推动认知或mRS评分的变化。

该研究招募了轻度缺血性卒中后 3 个月内的患者(NIH 中风量表 (NIHSS) 评分 <8,并且预计不会导致改良 Rankin 量表 (mRS) 评分 >2。)。参与者在 1 年时进行MRI检查,在 1 年和 3 年时重复进行认知和 mRS 评估。采用纵向混合效应模型评估 Addenbrooke 认知考试修订版 (ACE-R) mRS 分数的变化。使用多变量模型来联合评估不断变化的认知/mRS 评分。

该研究小组招募了 264 名患者;平均年龄为 66.9 (SD 11.8) 岁;41.7% 是女性;mRS 评分中位数为 1(四分位距 1-2)。

(A)基线,(B) 1年和(C) 3年随访的ACE-R和mRS评分之间的横断面相关性

该研究主要结果为:

  1. 卒中一年后,标准化 WMH 体积与 1 ACE-R 评分的相关性(β = 0.25995% CI 0.407 0.11p = 0.001)比亚急性 WMH 体积和 ACE-R 评分相关性(β = 0.105, 95% CI 0.265 to 0.054, p = 0.195)更强。
  2. 3 mRS 评分与 3 ACE-R 评分相关(β = 0.27295% CI 0.429 0.115p = 0.001)。
  3. 基线 1 年联合评估的 ACE-R/mRS 评分的综合变化与 WMH 体积波动相关(F = 9.3p = 0.03)。

该研究表明,卒中后,波动变化的 WMH 意味着卒中 1 年后的WMH 体积与同时期的认知评分密切相关。卒中后认知和独立性的共同纵向下降是痴呆诊断的核心,与 WMH 体积增加有关。

原文出处

Impact of Small Vessel Disease Progression on Long-term Cognitive and Functional Changes After Stroke. Neurology Apr 2022, 98 (14) e1459-e1469; DOI: 10.1212/WNL.0000000000200005

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