阿尔茨海默病(AD)的脑微血管病会导致慢性灌注不足,并可能加速神经退行性变化。
我们假设微血管损伤可能已经存在于轻度认知障碍(MCI)中,并且可以使用经颅彩色编码超声检查(TCCS)和屏气操作来显示。
三组受试者(痴呆阶段的AD,MCI和认知正常对照)具有详细的神经心理学测试和低脑血管负担(无中风史,没有颅内或外动脉狭窄,脑MRI无严重血管病变),接受了收缩压峰值(PSV)的TCCS评估,平均流量(MFV),舒张末期速度(EDV)和阻力和搏动指数(RI,PI)双侧颅内大血管。使用双侧大脑中动脉(MCA)的屏气指数(BHI)评估脑血管储备能力。比较各组的超声参数,与神经心理学测试相关,并比较遗忘型和非遗忘型MCI亚型。
公元14年(3名男性,67.9±11.1年,MMSE18.0±4.6),24MCI(13名男性,71.9±7.3年,MMSE28.0±1.6),和24个风险因素匹配的对照(14名男性,67.8±6.4年,纳入MMSE29.1±1.2)。发现AD和对照组之间的MFV存在显着差异,EDV,RI,屏气后右侧MCAPI,在PSV中,MFV,屏气后左侧MCA的EDV,在左侧的BHI。左BHI与言语记忆测试呈正相关。
结果显示,AD患者的脑血管储备能力下降是脑血流动力学状态受损的标志,而没有严重的潜在动脉粥样硬化。这可以使用TCCS和BHI来识别。
Cerebral microangiopathy in Alzheimer\'s disease (AD) causes chronic hypoperfusion and probably accelerates neurodegenerative changes.
We hypothesize microvascular impairment could be present already in mild cognitive impairment (MCI) and can be revealed using transcranial color-coded sonography (TCCS) and the breath-holding maneuver.
Three groups of subjects (AD in the stage of dementia, MCI, and cognitively normal controls) with detailed neuropsychological testing and low cerebrovascular burden (no history of stroke, no intra- or extracranial artery stenoses, and no severe vascular lesions on brain MRI), underwent a TCCS assessment of peak systolic (PSV), mean flow (MFV), and end diastolic velocities (EDV) and resistance and pulsatility indices (RI, PI) in large intracranial vessels bilaterally. Cerebrovascular reserve capacity was assessed using the breath-holding index (BHI) in middle cerebral artery (MCA) bilaterally. The ultrasound parameters were compared between the groups, correlated with neuropsychological tests, and compared between amnestic and non-amnestic MCI subtypes.
Fourteen AD (3 males, 67.9±11.1 years, MMSE 18.0±4.6), 24 MCI (13 males, 71.9±7.3 years, MMSE 28.0±1.6), and 24 risk factor-matched controls (14 males, 67.8±6.4 years, MMSE 29.1±1.2) were enrolled. Significant differences were found between AD and controls in MFV, EDV, RI, PI in right MCA after breath holding, in PSV, MFV, EDV in left MCA after breath holding, and in BHI on the left side. The left BHI correlated positively with verbal memory test.
Results show decreased cerebrovascular reserve capacity in AD as a sign of impaired cerebral hemodynamic status without severe underlying atherosclerosis. This can be identified using TCCS and BHI.