부산대학교 도서관

Background and purpose: While hippocampal volumes have been extensively examined in cognitive impairment with patients, signal variation within the hippocampus commonly observed on MRI, described as hippocampal enlarged perivascular spaces (H-EPVS), have received less attention. There have been debates on the association between the degree of H-EPVS and cognitive impairment. The change in cerebrovascular pulsatility effects on glymphatic homeostasis and brain clearance. The compromised fluid and toxin clearance from brain is a causal role of EPVS. So I hypothesized that the degree of H-EPVS is related to decreased vascular circulation and cognitive impairment. My aim was to investigate risk factors of H-EPVS and the relation between H-EPVS and pulsatility index (PI), cognition particularly memory domain in nondementic elderly population.Methods: This study was based on data collected in asymptomatic elderly who took brain MRI and TCD in clinic of Samsung Medical Center health promotion center. Then subjects were clinically evaluated and underwent cognition test The Alzheimer’s Disease Assessment Scale-cognition sub-scale (ADAS-Cog), MMSE, and MoCA. A total of 109 subjects participated in the study following the screening process. The eligibilities for inclusion were age from 55 years to 85 years and MMSE score of 26 and above. Individuals with evidence of dementia, structural brain alternation including mass, stroke, psychiatric problem were excluded. All subjects gave a signed informed consent. Two neurologists rated H-EPVS manually. In case of disagreement a consensus meeting was held. I categorized in 3 degree scale according to the sum of H-EPVS in the left and right hippocampus: degree 0 (no H-EPVS), degree 1 (1-2 H-EPVS), and degree 2 (2 > H-EPVS).Results: The mean age of subjects was 65.2 years (SD = 5.94), 52.3 % (n = 57) subjects were men. Regarding H-EPVS 56.9% of individuals had at least 1. The degree of H-EPVS was found strongly associated with age (degree 2 vs. degree 1 vs. degree 0: 69.20 ± 6.93 vs. 65.70 ± 5.75 vs. 63.80 ± 5.43, p-value 0.030) and cognition particularly ADAS-cog memory score (degree 2 vs. degree 1 vs. degree 0: 14.88 ± 4.27 vs. 12.49 ± 4.56 vs. 11.4 ± 4.23, p-value 0.037). But the PI was not related to the degree of H-EPVS. ADAS-cog memory score was associated with degree 2 of H-EPVS and MTA scale-sum ≧ 4 (p value 0.035, p value 0.034). Multivariate models to determine predictors of ADAS-cog memory score, MTA scale score was found to be independently associated (MTA scale-sum ≧ 4, p-value 0.011). But the degree of H-EPVS was not found related to ADAS-cog memory score (Degree2, p-value 0.113). Hippocampal atrophy showed the mild correlation of H-EPVS (correlation efficient 0.273, p-value 0.004).Conclusions: In conclusion, the present findings strongly suggest that age do play a key role in the development of H-EPVS in nondementic elderly population. TCD parameters were not related to the degree of H-EPVS. Adjustment of multivariable factors, memory cognitive function was found to be independently associated with hippocampal atrophy but not the degree of H-EPVS.