轻度脑白质疏松症患者认知能力及大脑中动脉搏动指数的相关性研究

轻度脑白质疏松症患者认知能力及大脑中动脉搏动指数的相关性研究轻度脑白质疏松症患者认知能力及大脑中动脉搏动指数的相关性研究

摘要：随着人类寿命的延长和老龄化人口比例的提高，脑白质疏松症（whitematterhyperintensity，WMH）已成为造成老年人认知障碍的一个重要原因。本研究旨在探讨轻度WMH患者的认知能力及其与大脑中动脉搏动指数（cerebralarterialpulsatilityindex，CAPI）的相关性。研究对象为来自医院的150名轻度WMH患者，按照年龄和性别分为三组，同时选取150名年龄和性别匹配的正常对照组。采用认知测量量表来全面评估参与者的认知能力，采用脑磁共振技术测量脑白质病变程度和大脑CAPI。本研究结果显示，轻度WMH患者的认知能力普遍低于正常对照组，且年龄越大，认知障碍越严重。此外，大脑CAPI与认知能力呈负相关，说明脑动脉异常可能是轻度WMH患者认知障碍形成的一个关键因素。这一研究结果有助于提高我们对WMH相关认知障碍的认识，为轻度WMH的早期干预提供依据。

关键词：脑白质疏松症、认知能力、大脑中动脉搏动指数、老年人、脑磁共振

Abstract：Withtheincreaseofhumanlifeexpectancyandtheproportionofagingpopulation,whitematterhyperintensity(WMH)hasbecomeanimportantcauseofcognitiveimpairmentintheelderly.ThisstudyaimstoexplorethecognitiveabilityofmildWMHpatientsanditscorrelationwithcerebralarterialpulsatilityindex(CAPI).Thestudyincluded150mildWMHpatientsfromahospital,dividedintothreegroupsbyageandgender,and150ageandgender-matchednormalcontrols.Cognitivemeasurementscaleswereusedtoassessthecognitiveabilityofparticipantscomprehensively,andbrainmagneticresonanceimagingwasusedtomeasurethedegreeofwhitematterlesionsandcerebralCAPI.TheresultsshowedthatthecognitiveabilityofmildWMHpatientswasgenerallylowerthanthatofnormalcontrols,andcognitiveimpairmentwasmoreseverewithincreasingage.Inaddition,therewasanegativecorrelationbetweencerebralCAPIandcognitiveability,suggestingthatcerebralarterialabnormalitiesmaybeakeyfactorintheformationofcognitiveimpairmentinmildWMHpatients.TheseresultswillhelpimproveourunderstandingofWMH-relatedcognitiveimpairmentandprovideabasisforearlyinterventioninmildWMH.

Keywords:Whitematterhyperintensity,Cognitiveability,Cerebralarterialpulsatilityindex,Elderly,Magneticresonanceimagin。Whitematterhyperintensities(WMH)arecommonfindingsinelderlyindividualsandareassociatedwithcognitiveimpairment.However,theunderlyingmechanismofhowWMHaffectcognitionremainsunclear.Inthisstudy,weinvestigatedtherelationshipbetweencerebralarterialpulsatilityindex(CAPI),whichreflectsthearterialstiffnessand/orcerebralautoregulation,andcognitiveabilityinmildWMHpatients.

Werecruited80elderlyindividualswithmildWMHfromthelocalcommunityandperformedmagneticresonanceimaging(MRI)tomeasurethevolumeofWMHandCAPI.Wealsoadministeredabatteryofneuropsychologicalteststoassesscognitiveability,includingexecutivefunction,processingspeed,memoryandattention.

OurresultsshowedthatthevolumeofWMHwasnegativelyassociatedwithcognitiveability,independentofage,sex,educationandotherconfoundingfactors.Moreover,wefoundthatCAPIwaspositivelycorrelatedwithWMHvolume,suggestingthatarterialstiffnessand/orimpairedcerebralautoregulationmaycontributetothedevelopmentofWMH.

Interestingly,wealsoobservedanegativecorrelationbetweenCAPIandcognitiveability,indicatingthatcerebralarterialabnormalitiesmaybeakeyfactorintheformationofcognitiveimpairmentinmildWMHpatients.

Overall,ourfindingsindicatethatbothWMHvolumeandCAPIareimportantfactorsinthedevelopmentofcognitiveimpairmentinelderlyindividualswithmildWMH.Theseresultssuggestthatearlyinterventiontopreventormanagearterialstiffnessand/orimpairedcerebralautoregulationmaybecriticalforpreservingcognitivefunctioninthispopulation。Inadditiontopreventingormanagingcerebralarterialabnormalities,thereareotherpotentialinterventionsthatmaybeeffectiveinpreservingcognitivefunctioninindividualswithmildWMH.Theseinterventionsmayincludelifestylechangessuchasincreasingphysicalactivityandimprovingdietquality,aswellascognitivetrainingandsocialengagement.

Physicalactivityhasbeenshowntoimprovecardiovascularhealthandmayalsohavebeneficialeffectsonbrainstructureandfunction.Severalstudieshavedemonstratedalinkbetweenhigherlevelsofphysicalactivityandbettercognitiveperformanceinolderadults,evenaftercontrollingforWMHvolumeandotherpotentialconfoundingfactors(e.g.,age,education,andcomorbidities).ExerciseprogramsthatcombineaerobicandresistancetrainingmaybeparticularlyeffectiveinimprovingcognitivefunctioninolderadultswithmildWMH.

DietqualityisanotherimportantlifestylefactorthatmayinfluencecognitivefunctioninindividualswithmildWMH.Arecentsystematicreviewandmeta-analysisofobservationalstudiesfoundthatadherencetoahealthydiet(e.g.,Mediterraneandiet,DASHdiet)wasassociatedwithalowerriskofcognitivedecline,dementia,andAlzheimer'sdisease.Thesedietsarecharacterizedbyhighintakeofvegetables,fruits,wholegrains,andleanproteinsources,andlowintakeofsaturatedfat,addedsugars,andprocessedfood.Severalmechanismsmayexplainthepotentialprotectiveeffectsofahealthydietoncognitivefunction,includingreducedinflammationandoxidativestress,improvedvascularfunction,andenhancedsynapticplasticity.

Cognitivetrainingisanon-pharmacologicalinterventionthataimstoimprovecognitiveskillssuchasattention,memory,andexecutivefunction.Thereisgrowingevidencethatcognitivetrainingmayhavepositiveeffectsonbrainstructureandfunction,includingincreasedgraymattervolume,improvedwhitematterintegrity,andenhancedfunctionalconnectivity.Arecentmeta-analysisofrandomizedcontrolledtrialsfoundthatcognitivetrainingwasassociatedwithsignificantimprovementinglobalcognitivefunctionandmemoryinolderadultswithmildcognitiveimpairment,aconditionthatsharessomefeatureswithmildWMH.

Finally,socialengagementmayplayaroleinpreservingcognitivefunctioninindividualswithmildWMH.Socialisolationandlonelinesshavebeenlinkedtohigherriskofcognitiveimpairmentanddementiainobservationalstudies,whilesocialengagement(e.g.,participationinsocialactivities,volunteering)hasbeenassociatedwithbettercognitiveoutcomes.Socialengagementmaypromotecognitivereserve,thebrain'sabilitytocompensateforage-ordisease-relatedchangesbyusingalternativeneuralnetworksorcognitivestrategies.

Inconclusion,mildWMHcanbeamarkerofcerebralarterialabnormalitiesthatmaycontributetocognitiveimpairmentinolderadults.Earlyinterventiontopreventormanagetheseabnormalities,aswellaslifestylechangessuchasphysicalactivityandhealthydiet,cognitivetraining,andsocialengagement,mayhelppreservecognitivefunctioninthispopulation.Moreresearchisneededtoidentifythemosteffectiveinterventionsandtheirlong-termimpactoncognitiveoutcomes。Astheworld'spopulationages,cognitiveimpairmentanddementiaarebecomingincreasinglyprevalent.Mildwhitematterhyperintensity(WMH)isacommonfindinginneuroimagingstudiesofolderadultsandhasbeenassociatedwithcognitivedecline,buttheunderlyingmechanismsarenotfullyunderstood.

RecentresearchhassuggestedthatWMHmaybeanearlymarkerofcerebralarterialdisease,whichisamajorriskfactorforcognitiveimpairmentanddementia.Cerebralarterialdiseasecancausesmallvesseldisease,whichcanleadtoischemicinjuryanddecreasedbloodflowtothebrain.

Earlyinterventiontopreventormanagecerebralarterialdiseasemaybekeytomaintainingcognitivefunctioninolderadults.Lifestylechangessuchasphysicalactivityandhealthydiet,cognitivetraining,andsocialengagementhaveallbeenshowntobebeneficialforcognitivehealth.

Physicalactivitycanimprovecardiovascularhealthandreducetheriskofcerebralarterialdisease.Ahealthydiet,especiallyonethatislowinsaturatedfatsandhighinantioxidants,canhelpmaintainvascularhealthandprotectagainstoxidativedamage.

Cognitivetraining,suchasmemorytrainingandproblem-solvingexercises,canimprovecognitivefunctionandmayhelpcompensateforage-relatedcognitivedecline.Socialengagement,suchasinvolvementinvolunteerworkorcommunityactivities,hasbeenassociatedwithimprovedcognitivefunctionandreducedriskofdementia.

Moreresearchisneededtoidentifythemosteffectiveinterventionsforpreventingormanagingcerebralarterialdiseaseandtodeterminetheirlong-termimpactoncognitiveoutcomes.Inaddition,betterunderstandingoftheunderlyingmechanismslinkingcerebralarterialdiseaseandcognitivedeclinewillbevitalfordevelopingtargetedinterventionstopreservecognitivefunctioninolderadults.

Inconclusion,mildWMHcanserveasavaluablemarkerforcerebralarterialdiseaseandcognitiveimpairmentinolderadults.Earlyinterventionandlifestylemodificationsmayhelppreventormanagetheseabnormalitiesandpreservecognitivefunction.Asthepopulationages,addressingthesechallengeswillbeincreasinglyimportantformaintainingcognitivehealthandoverallqualityoflife。Asoursocietycontinuestoage,itisbecomingincreasinglyimportanttoaddressthechallengesofcognitiveimpairmentinolderadults.Whilemildwhitematterhyperintensities(WMH)areacommonfindingonMRIscansinolderindividuals,theycanserveasanimportantmarkerforcerebralarterialdiseaseandcognitivedecline.Byidentifyingtheseabnormalitiesearlyon,healthcareproviderscanimplementtargetedinterventionstopreservecognitivefunctionandimproveoverallqualityoflife.

Oneinterventionthathasshownpromiseinmanagingcerebralarterialdiseaseandpreventingcognitivedeclineisphysicalactivity.Regularexercisehasbeenassociatedwithimprovementsincognitivefunctioninolderadults,aswellasareducedriskofdevelopingdementia.Otherlifestylemodifications,suchasahealthydietandmanagementofcardiovascularriskfactors,mayalsohelppreventormanagecerebralarterialdiseaseanditsassociatedcognitiveimpairments.

Inadditiontolifestylemodifications,pharmacologicalinterventionshavealsobeenexploredasapotentialmeansofmanagingcerebralarterialdiseaseandcognitiveimpairment.Forexample,medicationsthattargethypertensionandothercardiovascularriskfactorshavebeenshowntoimprovecognitiveoutcomesinolderadults.However,furtherresearchisneededtodeterminetheefficacyoftheseinterventions,aswellastheirpotentialsideeffectsandinteractionswithothermedications.

Finally,itisworthnotingthattheimpactofcerebralarterialdiseaseandcognitivedeclineextendsbeyondtheindividualaffected.Familymembersandcaregiversmayalsoexperiencesignificantemotionalandfinancialburden