Sex-specific risk factors and clinical dementia outcomes for white matter hyperintensities in a large South Korean cohort.

IF 7.9 1区 医学 Q1 CLINICAL NEUROLOGY
Noah Schweitzer, Sang Joon Son, Rebecca C Thurston, Jinghang Li, Chang-Le Chen, Howard Aizenstein, Shaolin Yang, Bistra Iordanova, Chang Hyung Hong, Hyun Woong Roh, Yong Hyuk Cho, Sunhwa Hong, You Jin Nam, Dong Yun Lee, Bumhee Park, Na-Rae Kim, Jin Wook Choi, Jaeyoun Cheong, Sang Woon Seo, Young-Sil An, So Young Moon, Seung Jin Han, Minjie Wu
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引用次数: 0

Abstract

Objective: White matter hyperintensities (WMH) on brain MRI images are the most common feature of cerebral small vessel disease (CSVD). Studies have yielded divergent findings on the modifiable risk factors for WMH and WMH's impact on cognitive decline. Mounting evidence suggests sex differences in WMH burden and subsequent effects on cognition. Thus, we aimed to identify sex-specific modifiable risk factors for WMH. We then explored whether there were sex-specific associations of WMH to longitudinal clinical dementia outcomes.

Methods: Participants aged 49-89 years were recruited at memory clinics and underwent a T2-weighted fluid-attenuated inversion recovery (FLAIR) 3T MRI scan to measure WMH volume. Participants were then recruited for two additional follow-up visits, 1-2 years apart, where clinical dementia rating sum of boxes (CDR-SB) scores were measured. We first explored which known modifiable risk factors for WMH were significant when tested for a sex-interaction effect. We additionally tested which risk factors were significant when stratified by sex. We then tested to see whether WMH is longitudinally associated with clinical dementia that is sex-specific.

Results: The study utilized data from 713 participants (241 males, 472 females) with a mean age of 72.3 years and 72.8 years for males and females, respectively. 57.3% and 59.5% of participants were diagnosed with mild cognitive impairment (MCI) for males and females, respectively. 40.7% and 39.4% were diagnosed with dementia for males and females, respectively. Of the 713 participants, 181 participants had CDR-SB scores available for three longitudinal time points. Compared to males, females showed stronger association of age to WMH volume. Type 2 Diabetes was associated with greater WMH burden in females but not males. Finally, baseline WMH burden was associated with worse clinical dementia outcomes longitudinally in females but not in males.

Discussion: Older females have an accelerated increase in cerebrovascular burden as they age, and subsequently are more vulnerable to clinical dementia decline due to CSVD. Additionally, females are more susceptible to the cerebrovascular consequences of diabetes. These findings emphasize the importance of considering sex when examining the consequences of CSVD. Future research should explore the underlying mechanisms driving these sex differences and personalized prevention and treatment strategies.

Clinical trial registration: The BICWALZS is registered in the Korean National Clinical Trial Registry (Clinical Research Information Service; identifier, KCT0003391). Registration Date 2018/12/14.

韩国大型队列中白质高密度症的性别特异性风险因素和临床痴呆症结果。
目的:脑磁共振成像图像上的白质高密度(WMH)是脑小血管疾病(CSVD)最常见的特征。关于 WMH 的可改变风险因素以及 WMH 对认知能力下降的影响,研究结果众说纷纭。越来越多的证据表明,在 WMH 负担及其对认知的影响方面存在性别差异。因此,我们旨在确定WMH的性别特异性可改变风险因素。然后,我们探讨了 WMH 与纵向临床痴呆症结果之间是否存在性别特异性关联:我们在记忆诊所招募了 49-89 岁的参与者,对他们进行了 T2 加权流体增强反转恢复(FLAIR)3T MRI 扫描,以测量 WMH 体积。然后,我们又招募参与者进行了两次间隔 1-2 年的随访,测量了临床痴呆评级方框总和(CDR-SB)得分。我们首先探讨了哪些已知的可改变 WMH 风险因素在检测性别互动效应时具有显著性。此外,我们还测试了哪些风险因素在按性别分层时具有显著性。然后,我们还测试了 WMH 是否与临床痴呆的性别特异性纵向相关:研究利用了 713 名参与者(男性 241 人,女性 472 人)的数据,男性和女性的平均年龄分别为 72.3 岁和 72.8 岁。57.3%和59.5%的男性和女性参与者被诊断为轻度认知障碍(MCI)。被诊断患有痴呆症的男性和女性分别占 40.7% 和 39.4%。在 713 名参与者中,181 名参与者有三个纵向时间点的 CDR-SB 评分。与男性相比,女性的年龄与WMH体积的关系更为密切。在女性中,2 型糖尿病与更大的 WMH 负荷相关,但与男性无关。最后,基线WMH负荷与女性更差的临床痴呆症纵向结果有关,但与男性无关:讨论:随着年龄的增长,老年女性的脑血管负担会加速增加,因此更容易因 CSVD 而导致临床痴呆衰退。此外,女性更容易受到糖尿病的脑血管后果的影响。这些发现强调了在研究 CSVD 后果时考虑性别因素的重要性。未来的研究应探索驱动这些性别差异的潜在机制以及个性化的预防和治疗策略:BICWALZS已在韩国国家临床试验注册中心(Clinical Research Information Service;标识符,KCT0003391)注册。注册日期为2018/12/14。
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
Alzheimer's Research & Therapy
Alzheimer's Research & Therapy 医学-神经病学
CiteScore
13.10
自引率
3.30%
发文量
172
审稿时长
>12 weeks
期刊介绍: Alzheimer's Research & Therapy is an international peer-reviewed journal that focuses on translational research into Alzheimer's disease and other neurodegenerative diseases. It publishes open-access basic research, clinical trials, drug discovery and development studies, and epidemiologic studies. The journal also includes reviews, viewpoints, commentaries, debates, and reports. All articles published in Alzheimer's Research & Therapy are included in several reputable databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, MEDLINE, PubMed, PubMed Central, Science Citation Index Expanded (Web of Science) and Scopus.
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