重要性 随着年龄的增长，假设在磁共振成像（MRI）上血管周间隙（PVS）的可见度增加，这代表了脑组织间质液的引流受损，并可能反映了潜在的脑小血管疾病（SVD）。然而，在MRI上可见的大血管周围间隙（L-PVSs）（直径> 3 mm）是否与SVD相关联，并且老年人的认知能力下降尚不清楚。
目的 探讨L-PVSs是否与已建立的SVD MRI标记，认知能力下降和痴呆风险增加相关。
设计，环境和参与者 前瞻性，基于人群的年龄，基因/环境易感性-雷克雅未克研究在基线（2002年9月1日至2006年2月28日）评估了2612名参与者的大脑MRI研究中的L-PVS。参与者从2007年4月1日至2011年9月30日再次接受MRI检查，并在两个时间点进行平均5.2（0.2）年的平均（SD）神经心理学测试。数据分析于2016年8月1日至2017年5月4日进行。
暴露 L-PVS的存在，数量和位置。
主要结果和措施 MRI上发现的皮层下梗死，脑微出血和白质高信号的进展；认知能力下降定义为在记忆，信息处理速度和执行功能方面，基线和随访之间的综合评分变化；以及根据国际准则诊断的判决性痴呆事件。
结果 在2612名研究患者中（平均[SD]年龄，为74.6 [4.8]岁；女性为1542 [59.0％]），其中424例患有L-PVS，而2188例没有。L-PVS的患病率为16.2％（L-PVS的中位数为1；范围为1-17）。在调整了年龄，性别以及基线和随访扫描之间的间隔之后，L-PVS的存在与皮层下梗死的风险增加显着相关（风险比调整后为2.54； 95％CI为1.76-3.68），并且微出血（调整风险比为1.43； 95％CI为1.18-1.72），并且白质高信号量的5年进展更大。L-PVSs的存在还与信息处理速度的急剧下降有关，并且使血管性痴呆的风险增加了四倍以上。进一步调整遗传和脑血管危险因素后，所有关联均持续存在。
结论与相关性 大型PVS是SVD的MRI标记，与老年人血管相关认知障碍的发病机制有关。较大的PVS应纳入老年人血管认知功能障碍的评估中，并应作为潜在的干预目标。
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Large Perivascular Spaces Visible on Magnetic Resonance Imaging, Cerebral Small Vessel Disease Progression, and Risk of DementiaThe Age, Gene/Environment Susceptibility–Reykjavik Study
Importance With advancing age, an increased visibility of perivascular spaces (PVSs) on magnetic resonance imaging (MRI) is hypothesized to represent impaired drainage of interstitial fluid from the brain and may reflect underlying cerebral small vessel disease (SVD). However, whether large perivascular spaces (L-PVSs) (>3 mm in diameter) visible on MRI are associated with SVD and cognitive deterioration in older individuals is unknown.
Objective To examine whether L-PVSs are associated with the progression of the established MRI markers of SVD, cognitive decline, and increased risk of dementia.
Design, Setting, and Participants The prospective, population-based Age, Gene/Environment Susceptibility–Reykjavik Study assessed L-PVSs at baseline (September 1, 2002, through February 28, 2006) on MRI studies of the brain in 2612 participants. Participants returned for additional MRI from April 1, 2007, through September 30, 2011, and underwent neuropsychological testing at the 2 time points a mean (SD) of 5.2 (0.2) years apart. Data analysis was conducted from August 1, 2016, to May 4, 2017.
Exposures The presence, number, and location of L-PVSs.
Main Outcomes and Measures Incident subcortical infarcts, cerebral microbleeds, and progression of white matter hyperintensities detected on MRI; cognitive decline defined as composite score changes between baseline and follow-up in the domains of memory, information processing speed, and executive function; and adjudicated incident dementia cases diagnosed according to international guidelines.
Results Of the 2612 study patients (mean [SD] age, 74.6 [4.8] years; 1542 [59.0%] female), 424 had L-PVSs and 2188 did not. The prevalence of L-PVSs was 16.2% (median number of L-PVSs, 1; range, 1-17). After adjusting for age, sex, and interval between baseline and follow-up scanning, the presence of L-PVSs was significantly associated with an increased risk of incident subcortical infarcts (adjusted risk ratio, 2.54; 95% CI, 1.76-3.68) and microbleeds (adjusted risk ratio, 1.43; 95% CI, 1.18-1.72) and a greater 5-year progression of white matter hyperintensity volume. The presence of L-PVSs was also associated with a steeper decline in information processing speed and more than quadrupled the risk of vascular dementia. All associations persisted when further adjusted for genetic and cerebrovascular risk factors. The associations with cognitive outcomes were independent of educational level, depression, and other SVD MRI markers.
Conclusions and Relevance Large PVSs are an MRI marker of SVD and associated with the pathogenesis of vascular-related cognitive impairment in older individuals. Large PVSs should be included in assessments of vascular cognitive impairment in the older population and as potential targets for interventions.