Hippocampal atrophy and white matter lesions characteristics can predict evolution to dementia in patients with vascular mild cognitive impairment

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Journal of the Neurological Sciences Pub Date : 2024-08-06 DOI:10.1016/j.jns.2024.123163

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引用次数: 0

Abstract

Background

Vascular mild cognitive impairment (VMCI) is a transitional condition that may evolve into Vascular Dementia(VaD). Hippocampal volume (HV) is suggested as an early marker for VaD, the role of white matter lesions (WMLs) in neurodegeneration remains debated.

Objectives

Evaluate HV and WMLs as predictive markers of VaD in VMCI patients by assessing: (i)baseline differences in HV and WMLs between converters to VaD and non-converters, (ii) predictive power of HV and WMLs for VaD, (iii) associations between HV, WMLs, and cognitive decline, (iv)the role of WMLs on HV.

Methods

This longitudinal multicenter study included 110 VMCI subjects (mean age:74.33 ± 6.63 years, 60males/50females) from the VMCI-Tuscany Study database. Subjects underwent brain MRI and cognitive testing, with 2-year follow-up data on VaD progression. HV and WMLs were semi-automatically segmented and measured. ANCOVA assessed group differences, while linear and logistic regression models evaluated predictive power.

Results

After 2 years, 32/110 VMCI patients progressed to VaD. Converting patients had lower HV(p = 0.015) and higher lesion volumes in the posterior thalamic radiation (p = 0.046), splenium of the corpus callosum (p = 0.016), cingulate gyrus (p = 0.041), and cingulum hippocampus(p = 0.038). HV alone did not fully explain progression (p = 0.059), but combined with WMLs volume, the model was significant (p = 0.035). The best prediction model (p = 0.001) included total HV (p = 0.004) and total WMLs volume of the posterior thalamic radiation (p = 0.005) and cingulate gyrus (p = 0.005), achieving 80% precision, 81% specificity, and 74% sensitivity. Lower HV were linked to poorer performance on the Rey Auditory-Verbal Learning Test delayed recall (RAVLT) and Mini Mental State Examination (MMSE).

Conclusions

HV and WMLs are significant predictors of progression from VMCI to VaD. Lower HV correlate with worse cognitive performance on RAVLT and MMSE tests.

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海马体萎缩和白质病变特征可预测血管性轻度认知障碍患者向痴呆症的演变。

背景：血管性轻度认知障碍（VMCI）是一种过渡性疾病，可能演变为血管性痴呆（VaD）。海马体积（HV）被认为是 VaD 的早期标志物，但白质病变（WMLs）在神经变性中的作用仍存在争议：通过评估：(i) VaD转换者与非转换者之间的HV和WMLs基线差异；(ii) HV和WMLs对VaD的预测能力；(iii) HV、WMLs和认知能力下降之间的关联；(iv) WMLs对HV的作用，评估HV和WMLs作为VMCI患者VaD预测标志物的作用：这项纵向多中心研究包括来自 VMCI-Tuscany 研究数据库的 110 名 VMCI 受试者（平均年龄：74.33 ± 6.63 岁，60 名男性/50 名女性）。受试者接受了脑部核磁共振成像和认知测试，并获得了两年的 VaD 进展随访数据。对 HV 和 WML 进行了半自动分割和测量。方差分析评估了组间差异，线性和逻辑回归模型评估了预测能力：两年后，32/110 名 VMCI 患者进展为 VaD。转为VaD的患者HV较低（p = 0.015），丘脑后部辐射（p = 0.046）、胼胝体脾（p = 0.016）、扣带回（p = 0.041）和海马嵴（p = 0.038）的病变体积较大。单独的 HV 并不能完全解释疾病的进展（p = 0.059），但结合 WMLs 的体积，该模型具有显著意义（p = 0.035）。最佳预测模型（p = 0.001）包括丘脑后辐射的总 HV（p = 0.004）和总 WMLs 体积（p = 0.005）以及扣带回（p = 0.005），精确度达到 80%，特异性达到 81%，灵敏度达到 74%。较低的HV与雷伊听觉语言学习测试延迟回忆（RAVLT）和迷你精神状态检查（MMSE）的较差表现有关：结论：HV 和 WML 是 VMCI 向 VaD 发展的重要预测因素。较低的 HV 与 RAVLT 和 MMSE 测试中较差的认知表现相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the Neurological Sciences 医学-临床神经学

CiteScore

7.60

自引率

2.30%

发文量

313

审稿时长

22 days

期刊介绍： The Journal of the Neurological Sciences provides a medium for the prompt publication of original articles in neurology and neuroscience from around the world. JNS places special emphasis on articles that: 1) provide guidance to clinicians around the world (Best Practices, Global Neurology); 2) report cutting-edge science related to neurology (Basic and Translational Sciences); 3) educate readers about relevant and practical clinical outcomes in neurology (Outcomes Research); and 4) summarize or editorialize the current state of the literature (Reviews, Commentaries, and Editorials). JNS accepts most types of manuscripts for consideration including original research papers, short communications, reviews, book reviews, letters to the Editor, opinions and editorials. Topics considered will be from neurology-related fields that are of interest to practicing physicians around the world. Examples include neuromuscular diseases, demyelination, atrophies, dementia, neoplasms, infections, epilepsies, disturbances of consciousness, stroke and cerebral circulation, growth and development, plasticity and intermediary metabolism.