Risk Factors of Cerebral Microbleeds and Its Correlation with Cognitive Impairment

doi:10.3969/j.issn.1673-5765.2018.07.003

Abstract

Abstract:

Objective To examine the clinical characteristics and correlative factors of cognitive dysfunction in patients with cerebral microbleeds (CMBs). Methods A total of 30 patients with SVD and 30 age, sex and education-matched control subjects were recruited consecutively from department of neurology, Beijing Tongren hospital. The cognitive function of all participants were evaluated by neuropsychological tests, including mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA). The severity of white matter lesions was evaluated by the Fazekas scale, and the severity of CMBs by the microbleed anatomical rating scale (MARS). The correlation between the severity of CMBs and white matter lesions/ cognitive function were analyzed. Results We found that CMBs was related to global cognitive function deficits. The severity of CMBs was positively related to the severity of white matter lesions (r =0.431, P =0.03). The severity of CMBs was negatively related to the score of MoCA (r =-0.52, P =0.02). Conclusion CMBs was closely related to cognitive impairment. The severity of CMBs was negatively related to the score of MoCA, and the severity of CMBs was positively related to the severity of white matter lesions.

Key words: Small vessel disease; Cerebral microbleeds; Cognition

摘要：

目的探讨脑微出血（cerebral microbleeds，CMBs）患者认知功能损害的临床特征及其相关因素。

方法研究对象来自2016年6月-2017年12月就诊于首都医科大学附属北京同仁医院的30例CMBs 患者和30例年龄、性别、受教育程度相匹配的对照组，采用简易智力状态量表（mini-mental state examination，MMSE）和蒙特利尔认知量表（Montreal cognitive assessment，MoCA）评价认知功能。采用Fazekas量表评价脑白质病变的严重程度。CMBs组采用微出血解剖评分量表（microbleed anatomical rating scale，MARS）评估CMBs严重程度。分析CMBs严重程度与脑白质病变严重程度及认知障碍的相关性。

结果 CMBs组MMSE[（24.9±2.7）分 vs（28.0±1.8）分，P =0.002]和MOCA[（23.6±3.4）分 vs （26.2±3.0）分，P =0.003]评分均显著低于对照组；脑白质病变的严重程度（Fazekas评分）与CMBs的严重程度呈正相关（r =0.431，P =0.03）；MOCA评分与CMBs的严重程度呈负相关（r =-0.52，P =0.02）。

结论 CMBs患者存在明显的认知功能障碍，MOCA评分与脑微出血的严重程度负相关；脑白质病变程度与CMBs的严重程度正相关。

关键词: 脑小血管病; 脑微出血; 认知功能

LU Chang-Feng, YUAN Jun-Liang. Risk Factors of Cerebral Microbleeds and Its Correlation with Cognitive Impairment[J]. Chinese Journal of Stroke, 2018, 13(07): 651-655.

陆长峰, 袁俊亮. 脑微出血危险因素及其与认知功能的相关性研究[J]. 中国卒中杂志, 2018, 13(07): 651-655.

References

[1] PANTONI L. Cerebral small vessel disease：from

pathogenesis and clinical characteristics to

therapeutic challenges[J]. Lancet Neurol，2010，9

（7）：689-701.

[2] WARDLAW J M，SMITH C，DICHGANS M.

Mechanisms of sporadic cerebral small vessel disease：

insights from neuroimaging[J]. Lancet Neurol，2013，

12（5）：483-497.

[3] 中华医学会神经病学分会脑血管病学组. 中国脑小

血管病诊治共识[J]. 中华神经科杂志，2015，48（10）：

838-844.

[4] PASI M，SALVADORI E，POGGESI A，et

al. White matter microstructural damage in

small vessel disease is associated with Montreal

cognitive assessment but not with mini mental state

examination performances：vascular mild cognitive

impairment Tuscany study[J]. Stroke，2015，46（1）：

262-264.

[5] 《中国高血压基层管理指南》修订委员会. 中国高血

压基层管理指南（2014年修订版）[J]. 中华健康管理

学杂志，2015，30（1）：10-30.

[6] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南

（2013年版）[J]. 中华内分泌代谢杂志，2014，30（10）：

447-498.

[7] 中国成人血脂异常防治指南修订联合委员会. 中国

成人血脂异常防治指南解读（2016年修订版）[J]. 中

国循环杂志，2016，31（10）：937-939.

[8] 陈灏珠. 心脏病学[M]. 北京：人民卫生出版社，2003：

1203.

[9] HILAL S，SAINI M，TAN C S，et al. Cerebral

microbleeds and cognition：the epidemiology of

dementia in Singapore study[J]. Alzheimer Dis

Assoc Disord，2014，28（2）：106-112.

[10] LI X，YUAN J，YANG L，et al. The significant

effects of cerebral microbleeds on cognitive

dysfunction：An updated meta-analysis[J/OL].

PLoS One，2017，12（9）：e0185145. https：//doi.

org/10.1371/journal.pone.0185145.

[11] VAN ES A C，VAN DER GROND J，DE CRAEN A J，

et al. Cerebral microbleeds and cognitive functioning

in the PROSPER study[J]. Neurology，2011，77（15）：

1446-1452.

[12] WU R，FENG C，ZHAO Y，et al. A meta-analysis

of association between cerebral microbleeds

and cognitive impairment[J/OL]. Med Sci Monit，

2014，20：2189-2198. https：//doi.org/10.12659/

MSM.891004.

[13] XU X，CHAN Q L，HILAL S，et al. Cerebral

microbleeds and neuropsychiatric symptoms in

an elderly Asian cohort[J]. J Neurol Neurosurg

Psychiatry，2017，88（1）：7-11.

[14] UITERWIJK R，HUIJTS M，STAALS J，et

al. Subjective cognitive failures in patients with

hypertension are related to cognitive performance

and cerebral microbleeds[J]. Hypertension，2014，64

（3）：653-657.

[15] PAPMA J M，DE GROOT M，DE KONING I，et al.

Cerebral small vessel disease affects white matter

microstructure in mild cognitive impairment[J].

Hum Brain Mapp，2014，35（6）：2836-2851.

[16] AKOUDAD S，WOLTERS F J，VISWANATHAN

A，et al. Association of Cerebral Microbleeds With

Cognitive Decline and Dementia[J]. JAMA Neurol，

2016，73（8）：934-943.

[17] VAN NORDEN A G，VAN UDEN I W，DE

LAAT K F，et al. Cerebral microbleeds are related

to subjective cognitive failures：the RUN DMC

study[J]. Neurobiol Aging，2013，34（9）：2225-

2230.

[18] BRUNDEL M，KWA V I，BOUVY W H，et al.

Cerebral microbleeds are not associated with longterm

cognitive outcome in patients with transient

ischemic attack or minor stroke[J]. Cerebrovasc Dis，

2014，37（3）：195-202.

[19] MALKKI H. Cerebrovascular disorders：Cerebral

microbleeds linked to increased risk of cognitive

decline[J]. Nat Rev Neurol，2016，12（8）：432-433

[20] 陶珍，曹秉振. 脑微出血及其与血管性认知功能障碍

的关系[J]. 中国卒中杂志，2015，10（9）：778-781.

[21] TE M，ZHAO E，ZHENG X，et al. Leukoaraiosis

with mild cognitive impairment[J]. Neurol Res，2015，

37（5）：410-414.

[22] VERDELHO A，MADUREIRA S，FERRO J

M，et al. Physical activity prevents progression for

cognitive impairment and vascular dementia：results

from the LADIS（Leukoaraiosis and Disability）

study[J]. Stroke，2012，43（12）：3331-3335.

[23] 袁俊亮，王双坤，彭朋，等. 脑白质疏松症患者认知

功能损害的临床特征[J]. 中华医学杂志，2012，92

（3）：147-151.