C-11 PiB正子造影和自發性腦出血中風後長期認知障礙之相關性研究

Abstract

認知功能障礙，範疇包括輕微認知功能障礙和癡呆，是出血性腦中風存活者一個重要的研究課題。大約八成的出血性腦中風被診斷為原發性，其中以腦部小血管疾病為最常見的病因。現有證據顯示既有的微血管病變和累積的腦部實質傷害促進了出血性腦中風存活者長期後的認知功能障礙。我們這篇前瞻性的研究，招募了尚未癡呆的出血性腦中風存活者，讓他們接受 C-11 PiB正子掃描，以比較類澱粉掃描結果陽性和陰性病患長期的認知功能情形。我們的結果顯示，類澱粉掃描陽性結果和長期後的認知功能障礙有獨立相關性。我們的發現暗示著，腦部的類澱粉，不管是腦血管的或是腦實質的，都是出血性腦中風存活者長期後是否會發生認知功能障礙，一個重要的影響因子。

Cognitive impairment, including mild cognitive impairment and dementia, is a major issue and causes disabilities in ICH survivors. About 80% of ICH patients are diagnosed as primary ICH, with cerebral small vessel disease (CSVD) as the most common etiology. Current evidence suggests that pre-existing underlying microangiopathy and the related accumulation of parenchymal injuries contribute substantially to the long-term cognitive impairment in survivors of primary ICH. In this prospective cohort study, we included survivors of primary ICH without overt dementia who received C-11 PIB PET scan to compare the longitudinal cognitive outcomes of patients with positive and negative amyloid scans. We showed that a positive amyloid scan was independently associated with a 33% incidence per person-years and a 16-fold higher risk of dementia conversion. We also showed that a positive amyloid scan was independently associated with a 59% incidence per person-years and a 6-fold higher risk of cognitive decline. Our findings implicate that cerebral amyloid, which can be related to vascular or parenchymal β-amyloid, is an important factor for cognitive decline in patients harboring hemorrhagic CSVD.