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Alzheimers Dement:小血管病比阿尔茨海默病更能决定记忆力临床患者的扩散MRI改变

2021-06-30 MedSci原创 MedSci原创

在记忆临床患者中,SVD对弥散改变的影响远远超过AD,支持扩散测量作为SVD标志物的价值。

阿尔茨海默病(AD)和脑小血管病(SVD)是认知衰退和痴呆的两个主要原因。白质微结构的改变被认为是这两种情况的关键发现,并且一直与认知缺陷相关。在体内研究白质微结构最常用的方法是弥散张量成像(DTI),AD和SVD的典型发现是水扩散范围(平均扩散率)的增加和扩散方向性(部分各向异性)的减少,这可以在全脑和区域范围内检测到。尽管扩散改变作为有效的疾病标志物被广泛使用,并与临床缺陷密切相关,但对其潜在的病理知之甚少。

扩散张量成像(DTI)评估的微结构改变是阿尔茨海默病(AD)和小血管病(SVD)的关键发现。Sofia Finsterwalder等确定了每个条件对扩散变化的贡献。研究成果发表在Alzheimers Dement杂志。

研究概念和参与者选择流程图。样本涵盖阿尔茨海默病(AD)、混合性疾病和小血管病(SVD)。

该研究纳入了6个样本(N=365名参与者),涵盖了AD和SVD,包括基因定义的样本。通过DTI和自由水成像计算了扩散测量。使用简单的线性、多变量随机森林和基于体素的回归来评估AD生物标志物(淀粉样β、tau)、SVD成像标志物和扩散测量之间的关联。

简单回归分析。扩散测量与阿尔茨海默病(AD)生物标志物或小血管病(SVD)标志物之间的简单线性回归分析。标准化β由颜色表示。

多变量分析。随机森林回归分析用于估计阿尔茨海默病(AD)生物标志物(灰色条带)、小血管疾病(SVD)标志物(黑色条带)、年龄和性别(白色条带)相对于常规扩散张量成像(DTI)测量(未校正部分各向异性(FAu))的相对变量重要性,未修正平均扩散率(MDu),同时考虑所有其他变量(条件重要性)。行表示条件变量重要性的95%置信区间。

SVD标志物与扩散指标密切相关,在所有记忆临床样本的多变量分析中,SVD标志物的贡献率高于AD标志物。tau和扩散度量之间的体素分析不显著。

该研究用扩散张量技术研究了AD和SVD对脑微结构的影响。作为一个独特的特点,该研究包括了六个独立招募的样本,涵盖了AD、混合疾病和SVD。主要发现是在记忆性临床患者中,扩散MRI改变很大程度上由SVD决定。结果在所有记忆临床样本中是一致的,说明了该发现的稳健性。该研究有助于MRI扩散改变的解释和临床应用的发展。

在记忆临床患者中,SVD对弥散改变的影响远远超过AD,支持扩散测量作为SVD标志物的价值。

原文出处

Finsterwalder S, Vlegels N, Gesierich B, et al. Small vessel disease more than Alzheimer's disease determines diffusion MRI alterations in memory clinic patients. Alzheimers Dement. 2020;16(11):1504-1514. doi:10.1002/alz.12150

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