期刊
NEUROPATHOLOGY AND APPLIED NEUROBIOLOGY
卷 43, 期 5, 页码 409-418出版社
WILEY
DOI: 10.1111/nan.12363
关键词
microinfarct; dementia; small vessel disease; white matter lesions; lacunes; vascular risk factors; mobility; epidemiological neuropathology
资金
- Department of Health and Medical Research Council [MRC/G9901400, MRC U.1052.00.0013]
- MRC [MRC/G0900582]
- UKNIHR Biomedical Research Centre for Ageing and Age-related Disease
- Medical Research Council [G0502157, G0900582, G0400074, G0601022, G9901400, G1100540, G0900652] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0611-10084] Funding Source: researchfish
- MRC [G1100540, G0900582, G0400074, G0502157, G0601022, G9901400, G0900652] Funding Source: UKRI
IntroductionMicroinfarcts, small ischaemic foci common in ageing brain, are associated with dementia and gait dysfunction. We determined their relationship with dementia, mobility and cerebrovascular disease in an older population-representative brain donor cohort. These data on microinfarcts were evaluated in relation to pathological assessments of clinically significant cerebral small vessel disease (SVD). MethodsMicroinfarcts were assessed in the MRC Cognitive Function and Ageing Study (n = 331). Nine brain areas were staged according to the number of areas affected. Results36% of brains showed at least 1 microinfarct. Higher cortical microinfarct stage was associated with dementia at death (OR 1.41, 95% CI 1.02; 1.96, P = 0.038), whilst cortical and subcortical microinfarct stages were associated with impaired mobility (OR 1.36, 95% CI 1.05-1.74; P 0.018) and falls (OR 1.96, 95% CI 1.11-3.43; P = 0.02). Adding data on microinfarcts to a definition of SVD, based on white matter lesions (WMLs), lacunes and significant arteriosclerosis, were assessed by comparing area under ROC curve (AUC) with and without microinfarcts. SVD was significantly related to dementia status with or without inclusion of microinfarcts. Modelling potential pathological definitions of SVD to predict dementia or impaired mobility indicated optimal prediction using combined assessment of WMLs, lacunes and microinfarcts. ConclusionCortical (dementia) and subcortical microinfarcts (impaired mobility) are related to diverse clinical outcomes. Optimal pathological assessment of significant SVD in brain ageing is achieved based on WMLs, lacunes and microinfarcts and may not require subjective assessment of the extent and severity of arteriosclerosis.
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