The Risk Factors Of Cognitive Dysfunction Of Cerebral Small Vessel Disease And The Treatment Of Repetitive Transcranial Magnetic Stimulation

Objective: In aging society, lives of people are impacted by cerebral small vessel disease(CSVD), and attracted widespread attention. Small vessel disease is an important role in the pathogenesis of cerebrovascular disease in the elderly, and is the leading cause of cognitive impairment. CSVD is mainly classified to leukoaraiosis, lacunar infarction, micro bleeding and expanded perivascular space. Leukoaraiosis is the mainly imaging manifestation of CSVD. Blood pressure, blood lipids, and blood glucose is the classic risk factors for cerebrovascular disease; folic acid, vitamin B12, homocysteine is the risk factor presented in small vessel disease. And how these risk factors affect CSVD and its subtypes remained to be study. Cognitive impairment in CSVD patients is different from other types of cognitive disorders. Montreal Cognitive Assessment(Mo CA) to evaluate cognitive function is the classical tool, and research with Mo CA to evaluation CSVD cognitive function shows good sensitivity. Therefore, this study observed the correlation between leukoaraiosis and cognitive function in patients with Mo CA Scale, and the correlation between leukoaraiosis and related risk factors.With the advancement of the aging population and the increasing proportion of society, suffering from cerebral small vessel disease and cognitive dysfunction in patients are more and more. This decease with society, families and the patients themselves is being a major social problem. Therefore, to explore a safety and effective method for treatment cognitive impairment of the elderly is particularly important. Repetitive transcranial magnetic magnetic stimulation(r TMS) is attended by peoples because of its safety, non-invasive, and no side effects. r TMS as a new neurophysiological techniques have been used in clinical, to increase cerebral blood flow, regulated cortical excitability, improving brain blood circulation, affecting the brain neurotransmitter metabolism, improved cognitive function. Therefore, in this study we applied r TMS to small vessel disease, and observed the efficacy of r TMS to the cognitive dysfunction of leukoaraiosis.Methods:1 Inclusion criteria: subjects with cerebral small vessel disease from December 2013 to December 2014, the First Hospital of Hebei Medical University, Department of Neurology, outpatient and inpatient. meeting the following criteria: Age between 60-75 years old, T2 WI and FLAIR MRI imaging performance as follows: Leukoaraiosis; no cortex and watershed stroke, no diameter> 15 mm lesions in subcortical. Exclusion criteria: patients with mental illness; patients with brain injury and poisoning, infection, immune system diseases; with history of epilepsy; diagnosis of Alzheimer’s disease and frontotemporal dementia; MRI showed a lesion diameter greater than 1.5CM; fitted with a pacemaker implant metals; vision, hearing impairment, aphasia and other effects to examiner; complications of diabetes and heart, liver and kidney dysfunction; suffering from other serious diseases system.2 Subjects classificationAccording to radiographic grading of Abaron-Peretz, all Leukoaraiosis subjects were divided into three levels: I group, II group, III group.I group included of 20 subjects, radiological classification for Abaron-Peretz 0 levels: Head MRI imaging and FLAIR with no hyperintense area.II group included of 20 subjects, in radiographic grade for Abaron-Peretz 1 and 2: MRI and FLAIR imaging former or posterior horn of the lateral ventricle, or former and posterior corner of the lateral ventricles are visible high signal area.III group included of 20 subjects, radiological classification for Abaron-Peretz 3 and 4: MRI and FLAIR imaging contiguous zone along the periventricular hyperintensity and corona radiata or periventricular hyperintensity area.Blood pressure, blood cholesterol, blood sugar levels, and folic acid, vitamin B12, homocysteine levels in blood were evaluated in patients. Application of Mo CA assesses cognitive function of all subjects.3 TMS method and groupThe frequency of r TMS is 15Hz; two sequences is completed at intervals of 30 seconds, a total of 1000 pulses everyday, continuous stimulation for 14 days. Experimental group received magnetic stimulation treatment on conventional treatment methods. The control group received conventional treatment in sham stimulation, with the reverse side of the coil, which can produce the same stimulation frequency sounds, but no magnetic field output.In the part of r TMS intervention to Leukoaraiosis, the grade II and III group were randomly divided into experimental groups(n = 20) and control group(n = 20) respectively, and affected r TMS with the stimulation and sham stimulation.Result:1 General InformationIn leukoaraiosis I group(n=20), subjects aged 66.1±4.3; leukoaraiosis II group(n=20), subjects aged 66.3 ± 4.5; leukoaraiosis III group(n=20), subjects aged 66.6 ± 4.4. Age was no significant difference among the three groups(P>0.05). In leukoaraiosis I group, the percentage of female subject was 45%; in leukoaraiosis II group, the percentage of female subject was 55%; in leukoaraiosis III group, the percentage of female subjects was 45%. The percentage of female subjects was no statistical difference among the three groups(P>0.05).2 Correlation analyses of leukoaraiosis, cognitive function, and risk factors Spearman correlation analysis were tested between Leukoaraiosis grading and blood pressure, blood lipids, blood glucose and blood folate, vitamin B12, homocysteine of each subject in 60 patients. The results showed that Leukoaraiosis grade lesions and blood pressure were significantly correlated(Correlation Coefficient, 0.368; P = 0.004); and significantlyCorrelated with vitamin B12 levels in blood of subjects(Correlation Coefficient, 0.368; P= 0.004); and also significantly correlated with the blood levels of homocysteine in(Correlation Coefficient, 0.292; P= 0.024). Leukoaraiosis classification with blood glucose(Correlation Coefficient, 0.123; P = 0.350), and blood lipids(Correlation Coefficient, 0.046; P=0.726) showed no significant correlation; with folic acid(Correlation Coefficient, 0.167; P=0.203) levels also showed no significant correlation.The grading of leukoaraiosis with Mo CA score performed Spearman correlation analysis in 60 patients. The results shown, Leukoaraiosis grading with Mo CA score were significantly correlated(Correlation Coefficient,-0.702; P= 0.001).The scores of cognitive function for each subject with blood pressure, blood lipids, blood glucose and blood folate, vitamin B12, homocysteine in 60 patients were performed with Spearman correlation analysis. The results showed that the cognitive function score of Leukoaraiosis with blood pressure were significantly correlated(Correlation Coefficient,-0.679; P=0.001), and with a significant correlation between blood glucose and the cognitive function score of Leukoaraiosis(Correlation Coefficient,-0.548; P= 0.001), and the cognitive function score with folate levels(Correlation Coefficient,-0.560; P=0.001) and vitamin B12 levels in subjects were with a significant correlation(Correlation Coefficient,-0.731; P=0.001), and the cognitive function score with homocysteine levels performed significantly correlated(Correlation Coefficient,-0.576; P=0.001). And the cognitive function score and serum lipids showed no significant correlation(Correlation Coefficient,-0.121; P = 0.355).3 rTMS improved cognitive function in subjects with leukoaraiosisCompared with the performance of previous stimulus, after a period of 14 days of high-frequency r TMS, the experimental group Mo CA scores were improved, howere, the result shown no significant difference(F=0.009, P=0.924). Mo CA sub-score of visuospatial and executive function, naming, language, attention, abstraction, delayed recall, orientation capability was observed. Compared with the performance of previous stimulus, after a period of 14 days of high-frequency r TMS, visuospatial and executive function scores(F=7.381, P=0.010), and language scores(F=14.378, P=0.001) were significantly improved in experimental group. Compared with the performance of previous stimulus, after a period of 14 days of high-frequency r TMS, the scores of naming, attention, abstraction, delayed recall, and orientation capability in experimental were no significant changes(P> 0.05).Compared with the p performance of previous stimulus, after a period of 14 days of high-frequency r TMS, the Mo CA scores in the control group were no significant change(P> 0.05). Mo CA sub-score of visuospatial and executive function, naming, language, attention, abstraction, delayed recall, orientation capability was observed. Compared with the performance of previous stimulus, after a period of 14 days of high-frequency r TMS, every sub-score were no significantly change(P> 0.05).Conclusion:These results shown, leukoaraiosis can affect cognitive function score of subjects, and the severity of leukoaraiosis and cognitive function scores were correlated; and leukoaraiosis degree, the cognitive function and risk factors of blood pressure, glucose, folic acid, vitamin B12, homocysteine were correlated. r TMS can improve the function of visuospatial and executive, and language significantly.