The Relationship Between Carotid Atherosclerosis And Vascular Cognitive Impairment: A Clinical Study In Lacunar Infarction Patients

Objective: To investigate the vascular cognitive impairment (VCI) morbidity of lacunar infarction, to research the relationship between carotid atherosclerosis and VCI, and to explore related risk factors of VCI.Methods: 97cases of lacunar infarction, excluding which results from coronary heart disease, have been tested with Mini-Mental State Examination (MMSE) and first series of Clinical Memory Scale(CMS) 17．5±3．5 days after their last lacunar infarction. According to the clinical diagnostic criteria of VCI which made by Wentze and his colleagues, subjects were divided into two groups: VCI and normal cognitive. All admitted subjects have been evaluated with MMSE, CMS, CED-S, HIS, NIHSS and ADL, been required their personal history, family history , and been graded their partner diseases and previous ailments. During 24-36 hours since they were admitted in hospital, cranial Magnetic Resonance Imaging (MRI), cardiogram and the level of blood pressure, the laboratory examinations such as blood glucose in empty stomach and second hour agter meal, blood grease, blood plasma ropy degree, blood plasma fibrinogen were carried out. Carotid atherosclerosis was assessed by two-dimensional color Doppler ultrasonography (2D-CDUS) in two groups at the same time . Statistical analysis was performed by SPSS (11．5) state software.Results: 1) The VCI morbidity(35．1%) of lacunar infarction was obviously higher than the normal older(5%).The VCI incidence(44．6%) of lacunar infarction with carotid atherosclerosis was also higher than those without carotid atherosclerosis( 21．9%), P<0．05．2) The morbidity of carotid atherosclerosis in VCI group(73．5%) was remarkably higher than normal cognitive group(49．2%), its difference was significant(P<0．05) . 3) Carotid atherosclerosis was assessed by 2D-CDUS. In VCI group double sides of inner diameter of CCA or ICA , intima-media thickness(IMT) of CCA or ICA and plaque scores(PS) were 7．61±0．88mm, 6．43±1．14mm, 2．12±1．28mm, 1．89±1．07mm, 5．12±3．86 cent, while in normal cognitive group were 8．18±1．06mm, 7．08±1．19mm, 1．49±0．78mm, 1．33±0．74mm, 2．83±3．97 cent. There were significant difference between the two groups (P<0．05) . The difference of carotid stenosis degree between them was also obvious (P<0．05) . The rate of light, midst grade and heavy carotid stenosis in VCI group were 41．2%, 23．5%, 8．8% while in normal cognitive group were 38．1%, 9．5%, 1．6%. Rates of midst grade and heavy stenosis in VCI group higher than those of normal cognitive group showed more apparently (P<0．01) . Despiting VCI group or normal cognitive group, plaque frequently occurred in bifurcation (BIF) and the imcept segment of internal carotid artery( ICA), instability malacoplakia gave priority to all kinds of plaque. 4) For the lacunar infarction with carotid atherosclerosis, MMSE scores, memory quotients(MQ), equivalent scale scores of the total scale and pointing memory, association learning, free picture recall, portrait character association recall items were significant decreases in patients with carotid atherosclerosis(P<0．05) . 5) Carotid plaque scores and carotid stenosis were the two indices representing carotid atherosclerosis. The correlation between them and MMSE scores, various equivalent scale scores of CMS have been analyzed separately, and the results showed obviously inverse correlation (P<0．05) . Carotid plaque scores also assumed linearity correlation with the equivalent scale scores of the total scale, the higher PS and the lower total scale scores. 6) The multivariate noncondition stepwise Logistic regress analysis was made after single variable analysis. The level of triglyeride(TG), low density lipoprotein cholesterd(LDL-C), blood plasma ropy degree, blood plasma fibrinogen, carotid plaque scores and carotid stenosis degree were variables in the equation in the end.Conclusions: 1) The VCI morbidity of lacunar infarction was obviously higher than the normal older. The morbidity of carotid atherosclerosis in lacunar infarction patients with VCI was also remarkably higher than those without VCI. 2) The appearance and development of carotid atherosclerosis were tied up tightly with VCI. Early diagnosis and therapy of carotid atherosclerosis should be gained more recognition by clinician. 3) Two-dimensional color Doppler ultrasonography was capable of reflecting the circumstances and severity of carotid atherosclerosis excellently, so that it could be used in diagnosis of carotid atherosclerosis. 4) The high level of blood plasma ropy degree and fibrinogen, blook grease metabolize disorder, carotid atherosclerosis were independent risk factors that awfully contributed to the occurrence and development of VCI. Therefore, energetical intervention of these risk factors was in a importance position to decrease VCI morbidity, improve VCI prognosis and cut down the incidence if vascular dementia (VD).