White matter hyperintensities and cholinergic degeneration as Lewy body disease

IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY
Sungwoo Kang, Seun Jeon, Yeoju Kim, Su-Hee Jeon, Minsun Choi, Young-gun Lee, Mijin Yun, Byoung Seok Ye
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引用次数: 0

Abstract

Objective

Although basal forebrain (BF) cholinergic degeneration and white matter hyperintensities (WMHs) are important in neurodegeneration in Alzheimer's disease (AD) and dementia with Lewy bodies (DLB), their relationships with dopaminergic degeneration and clinical manifestations remain unclear.

Methods

A total of 407 patients with cognitive impairment meeting the diagnostic criteria for AD, DLB, or both (AD+DLB) were assessed. All participants underwent 3T MRI, dopamine transporter (DAT) positron emission tomography, neuropsychological tests, and assessments for parkinsonism, cognitive fluctuation, visual hallucination, and rapid eye movement sleep behavior disorder (RBD). General linear and logistic regression models were used to investigate the relationships among BF volume, DAT uptake in the anterior caudate (DAT-AC), WMH volumes in anterior, posterior, periventricular, and deep regions, and clinical manifestations.

Results

DAT-AC was positively associated with BF volume and negatively associated with anterior periventricular WMH volume, but not with deep WMHs. Both deep and periventricular WMHs volumes were associated with hypertension and the number of microbleeds and lacunae. Lower BF volume and DAT-AC were independently associated with increased risk of cognitive fluctuation and visual hallucination, whereas lower DAT-AC was additionally associated with increased risk of RBD and greater parkinsonian severity. Both lower BF volume and DAT-AC were independently associated with widespread cognitive impairment, whereas higher anterior periventricular WMH volume was associated with executive dysfunction.

Interpretation

BF cholinergic degeneration and anterior periventricular WMHs are closely associated with dopaminergic degeneration. Anterior periventricular WMHs may represent axonal alterations caused by the interplay between Lewy body-related degeneration and vascular pathologies.

Abstract Image

路易体病的白质高信号和胆碱能变性。
目的:虽然基底前脑(BF)胆碱能变性和白质高信号(WMHs)在阿尔茨海默病(AD)和路易体痴呆(DLB)的神经变性中起重要作用,但它们与多巴胺能变性和临床表现的关系尚不清楚。方法:对407例符合AD、DLB或两者(AD+DLB)诊断标准的认知功能障碍患者进行评估。所有参与者都接受了3T MRI、多巴胺转运体(DAT)正电子发射断层扫描、神经心理测试,以及帕金森症、认知波动、视觉幻觉和快速眼动睡眠行为障碍(RBD)的评估。使用一般线性和逻辑回归模型研究BF体积、前尾状核(DAT- ac)的DAT摄取、前、后、室周和深区WMH体积与临床表现之间的关系。结果:DAT-AC与BF体积呈正相关,与前脑室周围WMH体积负相关,但与深部WMH无关。深室和室周WMHs体积与高血压、微出血和腔隙数量相关。较低的BF体积和DAT-AC与认知波动和视幻觉风险增加独立相关,而较低的DAT-AC与RBD风险增加和帕金森病严重程度增加额外相关。较低的BF体积和DAT-AC均与广泛的认知障碍独立相关,而较高的前脑室周围WMH体积与执行功能障碍相关。结论:BF胆碱能变性和前脑室周围wmh与多巴胺能变性密切相关。前脑室周围wmh可能代表路易体相关变性和血管病变之间相互作用引起的轴突改变。
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
Annals of Clinical and Translational Neurology
Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)
CiteScore
9.10
自引率
1.90%
发文量
218
审稿时长
8 weeks
期刊介绍: Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.
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