脑小血管病MRI表现对痴呆的预测作用

摘要/Abstract

摘要：

随着全球老龄化，痴呆发病率快速上升，而且痴呆具有不可逆性、缺乏有效治疗措施，故探索预测痴呆发生的有效指标成为关键。脑小血管病（cerebral small vessel disease，CSVD）被认为与痴呆密切相关，其颅脑磁共振成像（magnetic resonance imaging，MRI）可表现为腔隙（lacunes）、新发皮层下小梗死（recent small subcortical infarcts）、脑白质高信号（white matter hyperintensities，WMH）、扩大的血管周围间隙（enlarged perivascular spaces，EPVS）及脑微出血（cerebral microbleeds，CMB）等。本文通过综述CSVD颅脑MRI表现与痴呆相关性的研究进展,发现多发静息性或位于基底节区的腔隙性梗死（lacunar infarction，LI）或腔隙、重度WMH、多脑叶分布性脑叶微出血（lobar microbleeds，LMB），均可作为预测痴呆发生的有效指标。

文章导读： 通过综述CSVD颅脑MRI表现与痴呆相关性的研究进展，发现多发静息性或位于基底节区的LI或腔隙、
重度WMH、多脑叶分布性LMB均可作为预测痴呆发生的有效指标

关键词: 脑小血管病; 磁共振成像; 痴呆

Abstract:

Dementia has been irreversible, lack of effective treatment, and increasing rapidly as the global aging, so exploring the useful predictors of dementia became more important. Cerebral small vessel disease (CSVD) has been reported to be associated with all types of dementia. Features of CSVD seen on magnetic resonance imaging (MRI) include recent small subcortical infarcts, lacunes, white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS) and cerebral microbleeds (CMB). This paper has reviewed the research progress of CSVD and dementia, and made a conclusion that silent multiple lacunar infarctions, lacunes or lacunar infarctions in basal ganglia, severe WMH and multiple lobar microbleeds could be the predictors of dementia.

Key words: Cerebral small vessel disease; Magnetic resonance imaging; Dementia

李玲，周华东，王延江. 脑小血管病MRI表现对痴呆的预测作用[J]. 中国卒中杂志, 2015, 10(10): 883-887.

LI Ling, ZHOU Hua-Dong, WANG Yan-Jiang. Predictive Value of Cerebral Small Vessel Disease on Magnetic Resonance Imaging for Dementia[J]. Chinese Journal of Stroke, 2015, 10(10): 883-887.

参考文献

1 Wa rdlaw JM, Smi th EE, Bies sels GJ, e t a l .Neuroimaging standards for research into small

vessel disease and its cont r ibut ion to ageing

and neurodegeneration[J]. Lancet Neurol, 2013,

12:822-838.

2 Wardlaw JM, Smith C, Dichgans M. Mechanisms of

sporadic cerebral small vessel disease:insights from

neuroimaging[J]. Lancet Neurol, 2013; 12:483-497.

3 刘妮, 高培毅. 脑小血管病磁共振影像研究概况[J]. 中

国卒中杂志, 2014, 9:450-454.

4 Pantoni L. Cerebral small vessel disease:from

pathogenesis and clinical characteristics to therapeutic

challenges[J]. Lancet Neurol, 2010, 9:689-701.

5 Crystal HA, Schneider JA, Bennett DA, et al.

Associations of cerebrovascular and Alzheimer's

disease pathology with brain at rophy[J]. Cur r

Alzheimer Res, 2014, 11:309-316.

6 Sacco RL, Kasner SE, Broderick JP, et al. An updated

definition of stroke for the 21st century:a statement

for healthcare professionals from the American Heart

Association/American Stroke Association[J]. Stroke,

2013, 44:2064-2089.

7 Kitagawa K, Miwa K, Yagita Y, et al. Association

between carotid stenosis or lacunar infarction and

incident dementia in patients with vascular risk

factors[J]. Eur J Neurol, 2005, 22:187-192.

8 Makin SD, Turpin S, Dennis MS, et al. Cognitive

impairment after lacunar stroke:systematic review

and meta-analysis of incidence, prevalence and

comparison with other stroke subtypes[J]. J Neurol

Neurosurg Psychiatry, 2013, 84:893-900.

9 Blanco-Rojas L, Arboix A, Canovas D, et al.

Cognitive profile in patients with a first-ever lacunar

infarct with and without silent lacunes:a comparative

study[J]. BMC Neurol, 2013, 13:203.

10 Thong JY, Hilal S, Wang Y, et al. Association of

silent lacunar infarct with brain atrophy and cognitive

impairment[J]. J Neurol Neurosurg Psychiatry, 2013,

84:1219-1225.

11 Edwards JD, Jacova C, Sepehry AA, et al. A

quantitative systematic review of domain-specific

cognitive impairment in lacunar stroke[J]. Neurology,

2013, 80:315-322.

12 Narasimhalu K, Wiryasaputra L, Sitoh YY, et al. Poststroke

subjective cognitive impairment is associated

with acute lacunar infarcts in the basal ganglia[J]. Eur

J Neurol, 2013, 20:547-551.

13 Chen Y, Wang J, Zhang J, et al. Aberrant functional

networks connectivity and structural atrophy in

silent lacunar infarcts:relationship with cognitive

impairments[J]. J Alzheimers Dis, 2014, 42:841-850.

14 Soriano-Raya JJ, Miralbell J, López-Cancio E, et al.Deep versus periventricular white matter lesions and

cognitive function in a community sample of middleaged

participants[J]. J Int Neuropsychol Soc, 2012,

18:874-885.

15 Prins ND, Scheltens P. White matter hyperintensities,

cognitive impairment and dementia:an update[J]. Nat

Rev Neurol, 2015, 11:157-165.

16 Carmichael O, Schwarz C, Drucker D, et al.

Longitudinal changes in white matter disease and

cognition in the first year of the Alzheimer disease

neuroimaging initiative[J]. Arch Neurol, 2010,

67:1370-1378.

17 Li L, Wang Y, Yan J, et al. Clinical predictors of

cognitive decline in patients with mild cognitive

impairment:the Chongqing aging study[J]. J Neurol,

2012, 259:1303-1311.

18 Román GC, Kalaria RN. Vascular determinants of

cholinergic deficits in Alzheimer disease and vascular

dementia[J]. Neurobiol Aging, 2006, 27:1769-1785.

19 Okamoto Y, Yamamoto T, Kalar ia RN, et al.

Cerebral hypoperfusion accelerates cerebral amyloid

angiopathy and promotes cortical microinfarcts[J].

Acta Neuropathol, 2012, 123:381-394.

20 Heier LA, Bauer CJ, Schwar tz L, et al. Large

Virchow-Robin spaces:MR-clinical correlation[J].

AJNR Am J Neuroradiol, 1989, 10:929-936.

21 Hansen TP, Cain J, Thomas O, et al. Dilated

perivascular spaces in the Basal Ganglia are a

biomarker of small-vessel disease in a very elderly

population with dementia[J]. AJNR Am J Neuroradiol,

2015, 36:893-898.

22 Deramecourt V. Vascular neuropathology and

cognitive decline[J]. Rev Neurol (Paris), 2013,

169:765-771.

23 Yates PA, Villemagne VL, Ellis KA, et al. Cerebralmicrobleeds:a review of clinical, genetic, and

neuroimaging associations[J]. Front Neurol, 2014,

4:205.

24 Goos JD, van der Flier WM, Knol DL, et al. Clinical

relevance of improved mic robleed detect ion

by susceptibility-weighted magnetic resonance

imaging[J]. Stroke, 2011, 42:1894-1900.

25 Scheltens P, Goos JD. Dementia in 2011:Microbleeds

in dementia—singing a different ARIA[J]. Nat Rev

Neurol, 2012, 8:68-70.

26 Cordonnier C, van der Flier WM. Brain microbleeds

and Alzheimer's disease:innocent observation or key

player?[J]. Brain, 2011, 134:335-344.

27 Yates PA, Desmond PM, Phal PM, et al. Incidence

of cerebral microbleeds in preclinical Alzheimer

disease[J]. Neurology, 2014, 82:1266-1273.

28 Yates PA, Sirisriro R, Villemagne VL, et al. Cerebral

microhemorrhage and brain β-amyloid in aging and

Alzheimer disease[J]. Neurology, 2011, 77:48-54.

29 Goos JD, Teuni s sen CE, Veerhui s R, e t a l .

Microbleeds relate to altered amyloid-β metabolism

in Alzheimer's disease[J]. Neurobiol Aging, 2012,

33:1011.

30 Sperling RA, Jack CR Jr, Black SE, et al. Amyloidrelat

e d imaging abnormal i t ie s i n amyloidmodifying

therapeutic trials:recommendations

f rom the Alzheimer 's Associat ion Research

Roundtable Workgroup[J]. Alzheimers Dement,

2011, 7:367-385.

31 Huijts M, Duits A, van Oostenbrugge RJ, et al.

Accumulation of MRI Markers of Cerebral Small

Vessel Disease is Associated with Decreased

Cognitive Function. A Study in First-Ever Lacunar

Stroke and Hypertensive Patients[J]. Front Aging

Neurosci, 2013, 5:72.

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