Clinical Research Of Leukoaraiosis And Its Cognitive Function And Cerebral Blood Flow Regulation

Objective:1.To evaluate the ability of cerebral blood flow automatic regulation in patients with Leukoaraiosis(LA)by supine-to-standing dynamic cerebral blood flow monitoring test with transcranial Doppler.2.TCD and carotid artery ultrasound were combined to explore the correlation between patients with LA and their cognitive function and cerebral blood flow automatic regulation ability and Intracranial and extracranial hemodynamics.Methods: 1.A total of 30 patients who were examined by brain MRI and clinically diagnosed with LA were selected from the inpatients of the second ward of nerology in Dalian Central Hospital Affiliated to Dalian Medical University,30 patients with undiagnosed LA admitted were selected as the control group at the same time.After admission,the general clinical data including age,gender,smoking status,drinking status,hypertension status,history of diabetes mel itus were recorded.2.Patients in both groups underwent regular TCD examination,supine-to-standing dynamic cerebral blood flow monitoring test with transcranial Doppler and carotid ultrasound,record related parameters of the velocity of cerebral blood flow in the middle cerebral artery,carotid intima media thickness,to discuss the correlation between LA and automatic regulation of cerebral blood flow and intracranial and extracranial hemodynamics.3.Patients in the LA group were divided into two groups(Fazekas I,II was one group,and Fazekas III was one group)according to the results of brain MRI examination and Fazekas scale to further analyze the correlation between the level of white matter lesions and the automatic regulation of cerebral blood flow.4.Mini-mental State Examination and Montreal cognitive assessment were used to assess the cognitive function in groups.At the same time,according to the above scale results,the LA group was divided into the cognitive dysfunction group and the non-cognitive dysfunction group,to further analyze the correlation between the cognitive function and cerebral blood flow automatic regulation in patients with LA.Results:1.There were 30 patients in LA group,including 17 males and 13 females,with an average age of 69.09±6 years old.The overall proportion of smokers and drinkers was 46.67% and 26.67%,respectively.The prevalence of hypertension and diabetes was 86.67% and 63%,respectively.There was no significant difference in age,gender,smoking,drinking,hypertension,diabetes between the LA group and the control group(P>0.05).2.The W wave of CBFV curve appeared in both the LA group and the control group,and there was no statistical significance in the velocity of blood flow in the middle cerebral artery during supine position(we analyzed the maximum velocity of blood flow in the middle cerebral artery),pulse index,resistance index in the supine position,difference of supine-to-standing blood pressure monitoring and difference of supine-to-standing heart rate monitoring between the LA group and the control group(P>0.05).3.In the LA group,The curve slope,which also is descending and ascending branch slopes of W-wave(we use the maximum blood flow velocity,mean blood flow velocity and minimum blood flow velocity to calculate the velocity change rate of W wave fal ing branch and velocity change rate of W wave rising branch)was lower than that in the control group,the difference of the stationary segment of supine-to-standing middle cerebral artery blood flow velocity in the LA group was larger than that in the control group,the IMT thickness of LA group was higher than that of CON group,the cognitive level of LA group was lower than that of CON group.Statistical analysis showed significant differences(P<0.05).4.The LA group was further grouped according to the degree of white matter osteoporosis.Between the Fazekas III group and the Fazekas I/II group,the curve slope of the Fazekas III group was lower,and cognitive function(MMSE,MoCA score)was also lower,while the difference of the stationary segment of supine-to-standing middle cerebral artery blood flow velocity in the Fazekas III group was higher.Statistical analysis showed significant differences(P<0.05).5.The LA group was further grouped according to the assessment of cognitive function.Between the cognitive impairment group and the non-cognitive impairment group,the curve slope of the the cognitive impairment group was lower.While the difference of the stationary segment of supine-to-standing middle cerebral artery blood flow velocity in the cognitive impairment group was higher.Statistical analysis showed significant differences(P<0.05).Linear regression suggested that cognitive function(MMSE,MoCA score)was positively correlated with cerebral blood flow automatic regulation ability(we use descending and ascending branch slopes of W-wave)(P < 0.05).Conclusions:1.The cerebral blood flow automatic regulation function was different between LA group and control group.It suggests that the cerebral blood flow automatic regulation function of patients with LA is different from that of normal people and may be impaired.2.The more severe the degree of white matter looseness in patients with LA,the difference of cerebral blood flow automatic regulation ability between patients with LA and normal people is larger.And the more impaired their cognitive function was.3.There may be a linear correlation between their cognitive function and the ability of cerebral blood flow automatic regulation in patients with LA,which is a positive correlation.That is,the more severely their cognitive function was impaired,the greater the difference in their ability of cerebral blood flow automatic regulation was compared with that of the normal people.4.White matter loss is associated with carotid intima-media thickness.5.TCD examination is an economical and convenient method to evaluate the ability of dynamic cerebral blood flow automatic regulation.