背景:在脑积水患者中通常观察到认知障碍。心室扩大压迫脑实质,尤其是白质(WM)。
目的:探讨脑积水患者脑室扩张与认知功能减退的关系是否由WM改变介导。
方法:回顾性。
方法:51例交通性脑积水患者(中位年龄,54年),50例梗阻性脑积水患者(中位年龄,49年),和53名对照受试者(平均年龄,50年)。
■扩散张量成像,3DT1BRAVO,3DFIESTA,立方体T2和FLAIR序列在3T。
结果:DTI参数(骨架化分数各向异性(FA),骨架化平均扩散系数(MD),使用FSL软件提取骨架化平均扩散系数p(PSMD)的峰宽。全球,脑室周围,和深白质高强度(WMH)体积,心室扩大程度(Evans指数),和其他常规成像标记(腔隙和血管周围空间的数量,颅内和脑体积)使用联合成像智能提取。认知测试包括蒙特利尔认知评估(MoCA),时钟绘图测试(CDT),词汇流畅性测试(VFT)。
方法:多元线性回归分析,调解分析,优势分析。P值<0.05被认为是显著的。
结果:心室扩张程度,DTI参数,和认知功能评分是相互关联的。骨架化的FA值(β=-0.0917,95%置信区间(CI):-0.205,-0.024)和归一化的全局WMH体积(β=-0.0635,95%CI:-0.13,-0.0005)共同介导了37.2%的Evans指数与MoCA之间的关联。对于脑室周围的WMHs发现了类似的因果途径,但对于深层的WMHs则没有。显性分析表明,骨架化FA值对认知的影响大于WMH体积。骨架化的FA值还介导了Evans指数与CDT(β=-0.0897,95%CI:-0.165,-0.026)和VFT(β=-0.1589,95%CI:-0.27,-0.083)之间的关联。
结论:WM改变是脑积水患者心室扩张和认知功能下降之间的因果关系。
方法:3.
■第三阶段。
BACKGROUND: Cognitive impairment is commonly observed in hydrocephalus patients. Ventricular enlargement compresses brain parenchyma, especially the white matter (WM).
OBJECTIVE: To investigate whether the relationship between ventricular dilation and cognitive decline in hydrocephalus patients is mediated by WM alterations.
METHODS: Retrospective.
METHODS: 51 communicating hydrocephalus patients (median age, 54 years), 50 obstructive hydrocephalus patients (median age, 49 years), and 53 control subjects (median age, 50 years).
UNASSIGNED: Diffusion tensors imaging, 3D T1 BRAVO, 3D FIESTA, CUBE T2, and FLAIR sequences at 3T.
RESULTS: DTI parameters (skeletonized fractional anisotropy (FA), skeletonized mean diffusivity (MD), and peak width of skeletonized mean diffusivity p(PSMD)) were extracted using FSL software. Global, periventricular, and deep white matter hyperintensity (WMH) volumes, degree of ventricular enlargement (Evans index), and other conventional imaging markers (number of lacunes and perivascular spaces, intracranial and brain volume) were extracted using united imaging intelligence. Cognitive tests included Montreal cognitive assessment (MoCA), clock drawing test (CDT), and vocabulary fluency test (VFT).
METHODS: Multivariable linear regression analysis, mediation analyses, and dominance analysis. P-value <0.05 was considered significant.
RESULTS: The degree of ventricular dilation, DTI parameters, and cognitive function scores were interrelated. The skeletonized FA values (β = -0.0917, 95% confidence interval (CI): -0.205, -0.024) and normalized global WMH volume (β = -0.0635, 95% CI: -0.13, -0.0005) together mediated 37.2% of the association between Evans index and MoCA. A comparable causal pathway was found for periventricular WMHs but not for deep WMHs. Dominance analysis indicated skeletonized FA values had a greater impact on cognition than WMH volume. The skeletonized FA values also mediated the association between Evans index and CDT (β = -0.0897, 95% CI: -0.165, -0.026) and VFT (β = -0.1589, 95% CI: -0.27, -0.083).
CONCLUSIONS: WM alterations were causal mediators between ventricular dilation and cognitive decline in hydrocephalus patients.
METHODS: 3.
UNASSIGNED: Stage 3.