Amyloid, neurodegeneration, and small vessel disease as predictors of dementia in the oldest-old

被引:44
作者
Lopez, Oscar L. [1 ,2 ]
Klunk, William E. [2 ]
Mathis, Chester [3 ,4 ]
Coleman, Rhaven L. [3 ]
Price, Julie [3 ]
Becker, James T. [1 ,2 ,5 ]
Aizenstein, Howard J. [2 ]
Snitz, Beth [1 ]
Cohen, Ann [3 ]
Ikonomovic, Milos [1 ]
McDade, Eric [1 ]
DeKosky, Steven T. [8 ]
Weissfeld, Lisa [6 ]
Kuller, Lewis H. [7 ]
机构
[1] Univ Pittsburgh Sch Med, Dept Neurol, Pittsburgh, PA 15261 USA
[2] Univ Pittsburgh Sch Med, Dept Psychiat, Pittsburgh, PA USA
[3] Univ Pittsburgh Sch Med, Dept Radiol, Pittsburgh, PA USA
[4] Univ Pittsburgh Sch Med, Dept Pharmaceut Sci, Pittsburgh, PA USA
[5] Univ Pittsburgh Sch Med, Dept Psychol, Pittsburgh, PA USA
[6] Univ Pittsburgh Sch Med, Dept Biostat, Pittsburgh, PA USA
[7] Univ Pittsburgh Sch Med, Dept Epidemiol, Grad Sch Publ Hlth, Pittsburgh, PA USA
[8] Univ Virginia Sch Med, Dept Neurol, Charlottesville, VA USA
关键词
MILD COGNITIVE IMPAIRMENT; WHITE-MATTER HYPERINTENSITIES; PITTSBURGH COMPOUND-B; ALZHEIMERS-DISEASE; CARDIOVASCULAR HEALTH; GINKGO-BILOBA; RISK-FACTORS; PET; DEPOSITION; BETA;
D O I
10.1212/WNL.0000000000000977
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To examine the association between brain structural changes and beta-amyloid deposition, and incident dementia in 183 elderly subjects without dementia (mean age 85.5 years) 2 years later. Methods: Subjects had a brain structural MRI scan and a PET scan with C-11-labeled Pittsburgh compound B (PiB) in 2009, and were evaluated clinically in 2011. Results: At baseline evaluation, of the 183 participants (146 cognitively normal [CN]); 37 mild cognitive impairment [MCI]), 139 (76%) were PiB+, had small hippocampal volume (<25th percentile), or had high white matter lesion (WML) volume (>75th percentile). Two years later, 111 (61%) were classified as CN, 51 (28%) as MCI, and 21 (11%) as dementia. At baseline, 51% of the CN participants and 67.5% of the MCI cases were PiB+. Thirty percent of the CN and 51% of the MCI cases had small hippocampi, and 24% of the CN and 40.5% of the MCI cases had abnormal WMLs. Of the 21 participants who progressed to dementia, 20 (95%) had at least one imaging abnormality. Only 3 (14%) were only PiB+, 1 (5%) had only small hippocampi, 1 (5%) had only WMLs, 1 (5%) was biomarker negative, and the other 16 had various pairs of imaging abnormalities. Continuous variables of PiB retention, left and right hippocampal volume, and WML volume were independent predictors of dementia in a logistic regression analysis controlling for age, sex, education level, and Mini-Mental State Examination scores. Conclusions: The prevalence of beta-amyloid deposition, neurodegeneration (i. e., hippocampal atrophy), and small vessel disease (WMLs) is high in CN older individuals and in MCI. A combination of 2 or 3 of these factors is a powerful predictor of short-term incidence of dementia.
引用
收藏
页码:1804 / 1811
页数:8
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