血管性认知障碍的神经心理学和影像学表现研究进展

doi:10.3969/j.issn.1673-5765.2023.11.002

摘要/Abstract

摘要： 血管性认知障碍是脑血管病变及其危险因素导致的认知功能下降，已逐渐成为当代社会的重大公共卫生问题。神经心理学和影像学表现是血管性认知障碍诊断和分型的“金标准”。本文将回顾神经心理学和影像学在血管性认知障碍精准诊断和进展预测等临床应用方面的研究进展，除了卒中后认知障碍和皮质下缺血性血管性认知障碍外，本文还关注了低灌注性认知障碍和混合型认知障碍的研究进展。

文章导读： 本文综述了对血管性认知障碍较为敏感的神经心理学和影像学指标，并关注了仍处于可干预阶段的低灌注性认知障碍和混合型认知障碍。

关键词: 血管性认知障碍; 神经心理学; 影像学

Abstract: Vascular cognitive impairment (VCI) is a decline in cognitive function caused by cerebrovascular disease and its risk factors, which has gradually become a major public health problem in the society. Neuropsychology and imaging findings are well-recognized standards of diagnosis and classification of VCI. This paper reviewed the advances in neuropsychology and imaging in clinical applications to accurately diagnose and predict the progression of VCI. In addition to post-stroke cognitive impairment and subcortical ischemic VCI, this paper also discussed the research advances in hypoperfusion cognitive impairment and mixed cognitive impairment.

Key words: Vascular cognitive impairment; Neuropsychology; Imaging

程安琪, 刘彩燕, 徐蔚海. 血管性认知障碍的神经心理学和影像学表现研究进展[J]. 中国卒中杂志, 2023, 18(11): 1222-1227.

CHENG Anqi, LIU Caiyan, XU Weihai. Advances in Clinical Research of Neuropsychology and Imaging of Vascular Cognitive Impairment[J]. Chinese Journal of Stroke, 2023, 18(11): 1222-1227.

参考文献

[1] VAN DER FLIER W M，SKOOG I，SCHNEIDER J A，et al. Vascular cognitive impairment[J/OL]. Nat Rev Dis Primers，2018，4：18003[2023-07-10]. https://doi.org/10.1038/nrdp.2018.3.
[2] LO J W，CRAWFORD J D，DESMOND D W，et al. Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups[J/OL]. Neurology，2019，93（24）：e2257-e2271[2023-07-10]. https://doi.org/10.1212/WNL.0000000000008612.
[3] KALARIA R N. Neuropathological diagnosis of vascular cognitive impairment and vascular dementia with implications for Alzheimer’s disease[J]. Acta Neuropathol，2016，131（5）：659-685.
[4] SKROBOT O A，BLACK S E，CHEN C，et al. Progress toward standardized diagnosis of vascular cognitive impairment：guidelines from the vascular impairment of cognition classification consensus study[J]. Alzheimers Dement，2018，14（3）：280-292.
[5] PINTER D，ENZINGER C，GATTRINGER T，et al. Prevalence and short-term changes of cognitive dysfunction in young ischaemic stroke patients[J]. Eur J Neurol，2019，26（5）：727-732.
[6] YANG Y M，ZHAO Z M，WANG W，et al. Trends in cognitive function assessed by a battery of neuropsychological tests after mild acute ischemic stroke[J/OL]. J Stroke Cerebrovasc Dis，2020，29（7）：104887[2023-07-10]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104887.
[7] HAMILTON O K L，BACKHOUSE E V，JANSSEN E，et al. Cognitive impairment in sporadic cerebral small vessel disease：a systematic review and meta-analysis[J]. Alzheimers Dement，2021，17（4）：665-685.
[8] LO J W，CRAWFORD J D，DESMOND D W，et al. Short-term trajectories of poststroke cognitive function：a STROKOG collaboration study[J/OL]. Neurology，2023，100（23）：e2331-e2341[2023-07-10]. https://doi.org/10.1212/WNL.0000000000207281.
[9] VAN RIJSBERGEN M W A，MARK R E，KOP W J，et al. Psychological factors and subjective cognitive complaints after stroke：beyond depression and anxiety[J]. Neuropsychol Rehabil，2019，29（10）：1671-1684.
[10] 司倩倩，程安琪，范晓媛，等. 颅内动脉粥样硬化性狭窄与认知功能的关系研究[J]. 中国卒中杂志，2023，18（4）：418-427.
SI Q Q，CHENG A Q，FAN X Y，et al. Relationship between intracranial atherosclerotic stenosis and cognition[J]. Chin J Stroke，2023，18（4）：418-427.
[11] CHANG WONG E，CHANG CHUI H. Vascular cognitive impairment and dementia[J]. Continuum（Minneap Minn），2022，28（3）：750-780.
[12] OTTOY J，OZZOUDE M，ZUKOTYNSKI K，et al. Amyloid-PET of the white matter：relationship to free water，fiber integrity，and cognition in patients with dementia and small vessel disease[J]. J Cereb Blood Flow Metab，2023，43（6）：921-936.
[13] PEROSA V，PRIESTER A，ZIEGLER G，et al. Hippocampal vascular reserve associated with cognitive performance and hippocampal volume[J]. Brain，2020，143（2）：622-634.
[14] ZHAO L，BIESBROEK J M，SHI L，et al. Strategic infarct location for post-stroke cognitive impairment：a multivariate lesion-symptom mapping study[J]. J Cereb Blood Flow Metab，2018，38（8）：1299-1311.
[15] WEAVER N A，KUIJF H J，ABEN H P，et al. Strategic infarct locations for post-stroke cognitive impairment：a pooled analysis of individual patient data from 12 acute ischaemic stroke cohorts[J]. Lancet Neurol，2021，20（6）：448-459.
[16] BIESBROEK J M，WEAVER N A，ABEN H P，et al. Network impact score is an independent predictor of post-stroke cognitive impairment：a multicenter cohort study in 2341 patients with acute ischemic stroke[J/OL]. Neuroimage Clin，2022，34：103018[2023-07-10]. https://doi.org/10.1016/j.nicl. 2022.103018.
[17] WEAVER N A，KANCHEVA A K，LIM J S，et al. Post-stroke cognitive impairment on the mini-mental state examination primarily relates to left middle cerebral artery infarcts[J]. Int J Stroke，2021，16（8）：981-989.
[18] COENEN M，KUIJF H J，HUENGES WAJER I M C，et al. Strategic white matter hyperintensity locations for cognitive impairment：a multicenter lesion-symptom mapping study in 3525 memory clinic patients[J]. Alzheimers Dement，2023，19（6）：2420-2432.
[19] LIU X S，CHENG R T，CHEN L，et al. Altered neurovascular coupling in subcortical ischemic vascular disease[J/OL]. Front Aging Neurosci，2021，13：598365[2023-07-10]. https://doi.org/10.3389/fnagi.2021.598365.
[20] PAN C S，CHEN G H，JING P，et al. Incremental value of stroke-induced structural disconnection in predicting global cognitive impairment after stroke[J]. Stroke，2023，54（5）：1257-1267.
[21] DEARBORN J L，ZHANG Y，QIAO Y，et al. Intracranial atherosclerosis and dementia：the atherosclerosis risk in communities（ARIC）study[J]. Neurology，2017，88（16）：1556-1563.
[22] MENG Y Y，YU K，ZHANG L G，et al. Cognitive decline in asymptomatic middle cerebral artery stenosis patients with moderate and poor collaterals：a 2-year follow-up study[J/OL]. Med Sci Monit，2019，25：4051-4058[2023-07-10]. https://doi.org/10.12659/MSM.913797.
[23] YE Q，BAI F. Contribution of diffusion，perfusion and functional MRI to the disconnection hypothesis in subcortical vascular cognitive impairment[J]. Stroke Vasc Neurol，2018，3（3）：131-139.
[24] DUERING M，BIESSELS G J，BRODTMANN A，et al. Neuroimaging standards for research into small vessel disease-advances since 2013[J]. Lancet Neurol，2023，22（7）：602-618.
[25] AMIN AL OLAMA A，WASON J M S，TULADHAR A M，et al. Simple MRI score aids prediction of dementia in cerebral small vessel disease[J/OL]. Neurology，2020，94（12）：e1294-e1302[2023-07-10]. https://doi.org/10.1212/WNL.0000000000009141.
[26] GEORGAKIS M K，FANG R，DÜRING M，et al. Cerebral small vessel disease burden and cognitive and functional outcomes after stroke：a multicenter prospective cohort study[J]. Alzheimers Dement，2023，19（4）：1152-1163.
[27] BANERJEE G，WILSON D，AMBLER G，et al. Cognitive impairment before intracerebral hemorrhage is associated with cerebral amyloid angiopathy[J]. Stroke，2018，49（1）：40-45.
[28] DHAMOON M S，CHEUNG Y K，MOON Y，et al. Cerebral white matter disease and functional decline in older adults from the northern Manhattan study：a longitudinal cohort study[J/OL]. PLoS Med，2018，15（3）：e1002529[2023-07-10]. https://doi.org/10.1371/journal.pmed.1002529.
[29] HAMILTON O K L，COX S R，OKELY J A，et al. Cerebral small vessel disease burden and longitudinal cognitive decline from age 73 to 82：the Lothian birth cohort 1936[J/OL]. Transl Psychiatry，2021，11（1）：376[2023-07-10]. https://doi.org/10.1038/s41398-021-01495-4.
[30] DE HAVENON A，SHETH K N，YEATTS S D，et al. White matter hyperintensity progression is associated with incident probable dementia or mild cognitive impairment[J]. Stroke Vasc Neurol，2022，7（4）：364-366.
[31] OTTOY J，OZZOUDE M，ZUKOTYNSKI K，et al. Vascular burden and cognition：mediating roles of neurodegeneration and amyloid PET[J]. Alzheimers Dement，2023，19（4）：1503-1517.
[32] ALBER J，ALLADI S，BAE H J，et al. White matter hyperintensities in vascular contributions to cognitive impairment and dementia（VCID）：knowledge gaps and opportunities[J/OL]. Alzheimers Dement（NY），2019，5：107-117[2023-07-10]. https://doi.org/10.1016/j.trci.2019.02.001.
[33] EGOROVA-BRUMLEY N，DHOLLANDER T，KHAN W，et al. Changes in white matter microstructure over 3 years in people with and without stroke[J/OL]. Neurology，2023，100（16）：e1664-e1672[2023-07-10]. https://doi.org/10.1212/WNL.0000000000207065.
[34] JIMÉNEZ-BALADO J，RIBA-LLENA I，GARDE E，et al. Prevalence of hippocampal enlarged perivascular spaces in a sample of patients with hypertension and their relation with vascular risk factors and cognitive function[J]. J Neurol Neurosurg Psychiatry，2018，89（6）：651-656.
[35] ARBA F，QUINN T J，HANKEY G J，et al. Enlarged perivascular spaces and cognitive impairment after stroke and transient ischemic attack[J]. Int J Stroke，2018，13（1）：47-56.
[36] BENJAMIN P，TRIPPIER S，LAWRENCE A J，et al. Lacunar infarcts，but not perivascular spaces，are predictors of cognitive decline in cerebral small-vessel disease[J]. Stroke，2018，49（3）：586-593.
[37] RUDILOSSO S，CHUI E，STRINGER M S，et al. Prevalence and significance of the vessel-cluster sign on susceptibility-weighted imaging in patients with severe small vessel disease[J/OL]. Neurology，2022，99（5）：e440-e452[2023-07-10]. https://doi.org/10.1212/WNL.0000000000200614.
[38] KONIECZNY M J，DEWENTER A，TER TELGTE A，et al. Multi-shell Diffusion MRI models for white matter characterization in cerebral small vessel disease[J/OL]. Neurology，2021，96（5）：e698-e708[2023-07-10]. https://doi.org/10.1212/WNL.0000000000011213.
[39] ZANON ZOTIN M C，YILMAZ P，SVEIKATA L，et al. Peak width of skeletonized mean diffusivity：a neuroimaging marker for white matter injury[J/OL]. Radiology，2023，306（3）：e212780[2023-07-10]. https://doi.org/10.1148/radiol.212780.
[40] FINSTERWALDER S，VLEGELS N，GESIERICH B，et al. Small vessel disease more than Alzheimer’s disease determines diffusion MRI alterations in memory clinic patients[J]. Alzheimers Dement，2020，16（11）：1504-1514.
[41] EGLE M，HILAL S，TULADHAR A M，et al. Prediction of dementia using diffusion tensor MRI measures：the OPTIMAL collaboration[J]. J Neurol Neurosurg Psychiatry，2022，93（1）：14-23.
[42] LIU M，NIE Z Y，LI R R，et al. Correlation of brain perfusion with white matter hyperintensity，brain atrophy，and cognition in patients with posterior cerebral artery stenosis and subjective cognitive decline[J/OL]. Med Sci Monit，2018，24：5729-5738[2023-07-10]. https://doi.org/10.12659/MSM.909188.
[43] CASOLLA B，CAPARROS F，CORDONNIER C，et al. Biological and imaging predictors of cognitive impairment after stroke：a systematic review[J]. J Neurol，2019，266（11）：2593-2604.
[44] ETHERTON M R，FOTIADIS P，GIESE A K，et al. White matter hyperintensity burden is associated with hippocampal subfield volume in stroke[J/OL]. Front Neurol，2020，11：588883[2023-07-10]. https://doi.org/10.3389/fneur.2020.588883.
[45] LIU C Y，YAN S，HOU B，et al. Mismatch of cognition and neural networks in asymptomatic middle cerebral artery steno-occlusive disease[J]. Eur J Neurol，2020，27（6）：1062-1065.
[46] JOKINEN H，KOIKKALAINEN J，LAAKSO H M，et al. Global burden of small vessel disease-related brain changes on MRI predicts cognitive and functional decline[J]. Stroke，2020，51（1）：170-178.
[47] QIN Q，QU J D，YIN Y S，et al. Unsupervised machine learning model to predict cognitive impairment in subcortical ischemic vascular disease[J]. Alzheimers Dement，2023，19（8）：3327-3338.
[48] GRAFF-RADFORD J，ARENAZA-URQUIJO E M，KNOPMAN D S，et al. White matter hyperintensities：relationship to amyloid and tau burden[J]. Brain，2019，142（8）：2483-2491.
[49] SCHEEL N，TARUMI T，TOMOTO T，et al. Resting-state functional MRI signal fluctuation amplitudes are correlated with brain amyloid-β deposition in patients with mild cognitive impairment[J]. J Cereb Blood Flow Metab，2022，42（5）：876-890.
[50] COGSWELL P M，LUNDT E S，THERNEAU T M，et al. Evidence against a temporal association between cerebrovascular disease and Alzheimer’s disease imaging biomarkers[J/OL]. Nat Commun，2023，14（1）：3097[2023-07-10]. https://doi.org/10.1038/s41467-023-38878-8.
[51] DEJONG N R，JANSEN J F A，VAN BOXTEL M P J，et al. Cognitive resilience depends on white matter connectivity：the Maastricht study[J]. Alzheimers Dement，2023，19（4）：1164-1174.