Effect Of Enlarged Perivascular Space In Hippocampus On Cognitive Function In Patients With Small Artery Occlusion Stroke

Background and Objective : Small artery occlusive stroke(SAO)accounts for about 30% to 42.3% of ischemic stroke.It is closely related to cognitive dysfunction.Enlarged perivascular space(EPVS)is one of the markers of cerebrovascular disease and may be a risk factor for cognitive impairment in patients with SAO.It is believed that the destruction of blood-brain barrier(BBB)plays an important role in the occurrence and development of cognitive impairment in patients with SAO.Enlarged perivascular space(EPVS)is one of the markers of cerebrovascular disease,which is closely related to the destruction of BBB.It may be a risk factor for cognitive impairment in patients with SAO.Hippocampal perivascular space enlargement(HEPVS)has a high proportion in SAO,but its relationship with cognitive impairment is not clear.Therefore,this study combined with neuropsychological tests and the latency and amplitude of P300 event-related potentials(P300 ERP)to analyze the effect of hippocampal H-EPVS on cognitive impairment in patients with SAO.Methods:Patients with SAO treated in NO.2 people’s Hospital from February 2019 to July 2020 were collected.All patients underwent P300 event-related potential(P300ERP)examination and a full set of cognitive function tests.The patients with the number of H-EPVS ≥ 7 were divided into extensive H-EPVS group(n = 61)and nonextensive H-EPVS group(n = 53).The vascular risk factors,cognitive scores and P300 ERP characteristics of extensive H-EPVS and non-extensive H-EPVS were compared and analyzed.Linear regression analysis was used to analyze the effects of H-EPVS grouping on P300 latency and cognitive function(AVLT immediate recall,AVLT delayed recall,information processing speed,verbal fluency)in patients with SAO by adjusting confounding factors such as age,sex and education years.Spearman rank correlation was used to analyze the correlation between the number of H-EPVS and the P300 latency,the information processing speed,the verbal fluency score and the AVLT delayed recall score.Finally,the receiver operating characteristic(ROC)was used to analyze the specificity and sensitivity of P300 latency to evaluate the effect on cognitive function in patients with SAO complicated with extensive H-EPVS.Results:A total of 114 patients with small artery occlusive stroke were included,and 61(53.5%)patients were found to have extensive H-EPVS.It was found that the P300 latency in patients with extensive H-EPVS(393.61 ±30.36ms)was significantly higher than with non-extensive H-EPVS(356.4 ±19.59 ms,t=-7.870,P<0.01),but there was no significant difference in P300 amplitude and overall cognitive function between the two groups(P>0.05).However,by comparing the scores of different cognitive areas between the two groups,it was found that the cognitive function(verbal fluency area)of patients with extensive H-EPVS(-0.41 ±0.50)was significantly lower than that with non-extensive H-EPVS(0.47±0.54,t=0.01,P<0.01).The auditory verbal learning test(AVLT)scores of delayed recall(-0.19±1.05 vs 0.22±0.89,t=2.258,P=0.026)and delayed recall(-0.22±0.94 vs 0.25±1.02,t=2.599,P=0.011)were also lower than non-extensive H-EPVS group.The information processing speed of the extensive H-EPVS group(0.11±0.49)was higher than non-extensive H-EPVS group(0.13±0.45,t=-2.709,P<0.01).After adjusting the confounding factors of gender,age and education years by linear regression analysis,it was found that H-EPVS grouping was associated with P300 latency(β=36.924,95%CI 26.852～46.996,P=0.000),AVLT delayed recall(β=-0.485,95%CI-0.863～-0.106,P=0.013),information processing speed(β=0.252,95%CI 0.069～0.434,P=0.007),and verbal fluency(β=-0.845,95%CI-1.045～-0.644,P=0.000).Further Spearman correlation analysis showed that the H-EPVS score of SAO patients was negatively correlated with cognitive function score(verbal fluency domain)(r = 0.705,P < 0.05),and positively correlated with P300 latency(r = 0.726,P = 0.000).There was a negative correlation between AVLT delayed recall,but the correlation coefficient was small(r = 0.216,P <0.01).There was no correlation with the field of information processing speed(P >0.05).ROC curve analysis showed that The index of P300 latency evaluation of cognitive impairment in patients with SAO complicated with extensive H-EPVS was0.796.Conclusion:Extensive H-EPVS has a high positive rate in patients with SAO.P300 latency was associated with verbal fluency in SAO patients with extensive HEPVS.