Comprometimento cognitivo vascular: leucoaraiose, hipocampos e espectroscopia de prótons ? Estudo preliminar
2013
Introducao: O continuum do comprometimento cognitivo vascular (CCV) compreende segmento nao demencia (CCV-ND), segmento demencia (CCV-D ou DV), sendo o subtipo mais frequente o CCV subcortical, e inclui, ainda, formas mistas (CCV + DA). Ressonância magnetica (RM) do cerebro e o metodo mais apropriado para avaliacao das lesoes vasculares, dimensao dos hipocampos e do espectro de protons (1HMRS). Objetivo: Comparar os valores de metabolitos dos hipocampos (HC) e da regiao do cingulo posterior (CP) em grupos de casos de CCV subcortical. Metodos: Casos (n = 55) foram selecionados a partir do banco de dados sobre CCV. Imagens obtidas por equipamento Signa Horizon LX-GE de 1,5T, com protocolo-padrao para aquisicao estrutural (incluindo FLAIR, T2 e aquisicao para 1H-MRS). Metabolitos estudados (relacoes) incluiram: Naa/Cr, Co/Cr e mI/Cr. Os casos foram definidos radiologicamente (leucoaraiose grau 3 pela escala de Fazekas modificada) e subdivididos de acordo com a escala de Leon (0-3) em dois em grupos hipocampais (grHC): grHC [0+1] e grHC [2+3]. Analise estatistica pelo ANOVA e Tukey. Resultados: A relacao Naa/Cr nos HC mostrou diferenca significativa entre o grHC [0+1] e o grHC [2+3], o que representa diminuicao de integridade (perda) neuronal no segundo, enquanto os CP desses grupos mantiveram os valores estaveis. Houve diferenca significativa entre o grHC [2+3] em relacao aos CP de ambos os grupos, enquanto o grHC [0+1] ficou compativel com os valores dos CP. Comparacao dos valores obtidos em estudos anteriores em CCL e DA mostrou o Naa/Cr com valor intermediario entre os do CCL e da DA nos HC e equivalencia de valores nos CP. Conclusao: A 1HMRS possibilita analisar o grau de perda neuronal, alem de alteracoes de membrana e neuroglial dessas regioes. Assim, podem ser obtidas informacoes para melhor compreender o continuum CCV subcortical (que pode incluir CCV + DA), visando determinar a contribuicao dessas duas patologias, caso haja, ao comprometimento cognitivo... Introduction: Vascular cognitive impairment (VCI) continuum comprisesno-dementia segment (VCI-ND), dementia segment (VCI-D or VaD), with subcortical VCI as the most frequent subtype, and additionally mixed forms (VCI + AD). Magnetic resonance imaging (MRI) of the brain is the most proper method for vascular lesions, hippocampal size, and proton spectrum (1HMRS) assessment. Objective: Comparison of the values of metabolites at the hippocampi (HC) and posterior cingulate (PC) region of groups of cases of subcortical VCI. Methods: Cases (n = 55) were selected from a database on VCI. Images were obtained with Signa Horizon LX-GE de 1.5T equipment and a standard protocol for structural and 1H-MRS acquisitions. Studied metabolites (reasons) were: Naa/Cr, Coh/Cr e mI/Cr. The cases were radiologically defined (grade 3 leucoaraiosis on modified Fazekas scale), and according de Leon?s scale (0-3) subdivided in two hippocampal groups (grHC): grHC[0+1] and grHC[2+3]. Statistical analysis with ANOVA and Tukey. Results: The reason Naa/Cr at the HC showed a significant difference between the grHC[0+1] and grHC[2+3], that represents a reduction of neuronal integrity (loss) in the latter, while at PC these groups maintained stable values. There was a significant difference between grHC [2+3] in relation to PC of both groups, while grHC [0+1] remained compatible with PC values. The comparison of the values obtained from previous studies on MCI and AD showed Naa/Cr with intermediate values between MCI and AD at the HC, and equivalence at the PC. Conclusion: 1HMRS allows for the analysis of the degree of neuronal loss, besides membrane and neuroglial changes of these regions. Thus, information may be obtained for a better understanding of the subcortical VCI continuum (that may include VCI + AD), aiming to determine the contribution of these two pathologies, if present, to the cognitive impairment...
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