| 알츠하이머병에서 혈관위험인자, 내측두엽위축과
백질병변이 인지기능에 미치는 영향 |
| 박진, 윤영신
a
김성희 김현진 강희진
b
최경규 정지향 |
| 이화여자대학교 의과대학 목동병원 신경과, 가톨릭대학교 의과대학 성빈센트병원 신경과
, 서울특별시 서남병원 신경과 |
| Impact of Vascular Risk Factors, Axial Medial Temporal Atrophy,
White Matter Hyperintensity on Cognitive Outcome in Alzheimer’s
Diseases |
| Jin Park |
| Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine,
Seoul, Korea
Department of Neurology
a
, St. Vincent Hospital, The Catholic University College of Medicine, Seoul, Korea
Department of Neurology
b
, Seoul Seunam Hospital, Seoul, Korea |
|
|
|
|
| Abstract |
Background: There is epidemiologic evidence to support vascular disease as a possible cause of Alzheimer’s dementia
(AD). The primary aim of this study was to determine the prevalence of vascular risk factors (vRFs) with respect to
various clinical measures, such as axial-rated medial temporal lobe atrophy (MTA), ischemic white-matter changes, and
cognition. The secondary aim was to determine the most significant clinical measure associated with cognitive outcome.
Methods: The study subjects comprised 198 probable AD and 38 subjective memory impairment?no cognitive
impairment controls (SMI-NCI), for whom medical data including history vRF-related blood tests, clinical dementia
evaluation, cognitive assessment, and brain MRI, were available. The grading of white-matter hyperintensities (WMHs)
was achieved using Fazekas’ method. MTA was graded by two neurologists independently based on axial T1-weighted
MRI images. The prevalence of risk factors for Koreans aged ≥65?years was reviewed for comparison.
Results: All vRFs except smoking were more severe in the AD group than in both the SMI-NCI group and Koreans aged
≥65 years, but the high prevalence of vRFs had no impact on WMH lesions, axial MTA, or cognitive outcome. Both
white-matter changes and MTA were significantly worse in AD than in SMI-NCI (p<0.001). The degree of MTA was
negatively correlated with WMH grade (p<0.001), but the severity of clinical dementia was correlated only with
increased axial MTA in AD (Instrumental Activities of Daily Living and Clinical Dementia Rating scores, p<0.001;
Clinical Dementia Rating-Sum of Boxes score, p<0.005).
Conclusions: WMHs and axial MTA were significantly more severe in the AD group than in the SMI-NCI subjects. The
findings of this study indicate that worsening of cognitive dysfunction in AD appears to be driven by MTA, which is
evident even in axial MTA visual grading, irrespective of WMH severity and the presence of vRFs. Key Words: Alzheimer’s disease, Vascular risk factors, Medial temporal atrophy, White matter |
|
PDF Links
Full text via DOI
Download Citation
