Study Of Cognitive Impairment In Patients With Chronic Cerebral Circulation Insufficiency By Magnetic Resonance Spectroscopy

Objective To use magnetic resonance spectroscopy to detect changes in brain material metabolism in patients with chronic cerebral circulation insufficiency(CCCI),and to explore the correlation between cognitive function decline and brain material metabolism in CCCI patients.Methods From March 2019 to September 2020,66 cases of CCCI patients diagnosed in the hospital and able to complete MMSE and Mo CA tests were collected.According to the cognitive function score,the patients were divided into a simple CCCI group and a CCCI secondary cognitive impairment group.Another 30 healthy volunteers were selected as the normal control group.The general clinical data of the above subjects were collected.And the 3.0T magnetic resonance imaging was used to perform conventional magnetic resonance sequence scanning to understand the presence or absence of WML on T2 WI and perform Fazekas classification.Perform magnetic resonance spectroscopy(MRS)measurement to obtain the area under the peak curve of N-acetylaspartic acid(NAA)、creatine(Cr)、choline(Cho)and myo-Inositol(m I),and calculate NAA/Cr、Cho /Cr、NAA/Cho、m I/Cr ratio.Two-independent sample t-test was used to analyze the general clinical data of the simple CCCI group and the CCCI secondary cognitive impairment group;the one-way analysis of variance was used to analyze the demographic characteristics and cognitive function scores and magnetic resonance spectroscopy indexes of the simple CCCI group,the CCCI secondary cognitive impairment group and the normal control group.The rank sum test was used to analyze the Fazekas classification of the three groups of white matter lesions.Spearman correlation analysis was used to analyze the correlation between the cognitive function score and the Fazekas classification.Pearson correlation analysis was used to analyze the correlation between the cognitive function scores of CCCI patients and the various indicators of MRS.Logistic regression was used to analyze the risk factors of cognitive impairment.Results1 Comparison of general clinical data between the simple CCCI group and the CCCI secondary cognitive impairment group.The level of systolic blood pressure,triglycerides,total cholesterol,low density lipoprotein cholesterol,and blood homocysteine in the CCCI secondary cognitive impairment group were Higher than the simple CCCI group,the difference was statistically significant(P<0.05).There was no significant difference in the level of body mass index,diastolic blood pressure,fasting blood glucose,high density lipoprotein cholesterol,blood uric acid between the two groups(P>0.05).Multivariate logistic regression analysis showed that the level of systolic blood pressure,total cholesterol,low density lipoprotein cholesterol,and blood homocysteine were related to the secondary cognitive impairment of CCCI.2 Of the 66 CCCI patients,42 cases had normal cognitive function.They belonged to the simple CCCI group,24 cases had secondary cognitive impairment.Compared with the simple CCCI group and the control group,the MMSE score and Mo CA score of the CCCI secondary cognitive impairment group were significantly reduced,and the difference was statistically significant(P<0.05);the comparison of the MMSE score and MOCA score between the simple CCCI group and the control group was no statistical significance(P>0.05).3 The control group,the simple CCCI group,and the CCCI secondary cognitive impairment group accounted for 20%,61.9% and 95.9% of patients with WML.The Fazekas grades of WML of the three groups were different,and the difference was statistically significant(P <0.05).The cognitive function score of the CCCI patients is negatively correlated with the Fazekas classification of WML.4 In the CCCI secondary cognitive impairment group,the NAA/Cr value(1.35±0.09)and NAA/Cho value(1.27±0.10)of the frontal lobe,the NAA/Cr value(1.38±0.08)and NAA/Cho value(1.29±0.04)of the temporal lobe,the NAA/Cr value(1.36±0.18)and NAA/Cho value(1.34±0.07)in the center of the semi-oval were lower than the simple CCCI group and the control group,the difference was statistically significant(P<0.05);There was no significant difference between the results of simple CCCI group and the normal control group(P>0.05).The temporal lobe m I/Cr value(0.79±0.25)of CCCI secondary cognitive impairment group was higher than that of the simple CCCI group and the control group,and the difference was statistically significant(P<0.05);The temporal lobe m I/Cr value of the normal control group and the simple CCCI group was no statistical difference(P>0.05);Compared with the simple CCCI group and the control group,the m I/Cr values of the frontal lobe and semi-oval center of the CCCI secondary cognitive impairment group were not statistically significant(P>0.05).There was no statistical difference in the Cho/Cr values of the three groups in the frontal lobe,temporal lobe,and semi-oval center of the dominant cerebral hemisphere(P>0.05).5 The MMSE and Mo CA scale scores of the CCCI patients are positively correlated with the NAA/Cr and NAA/Cho values of the brain regions of interest(frontal lobe,temporal lobe,semi-oval center),and negatively correlated with temporal lobe m I/Cr values.Conclusion 1 CCCI patients may experience cognitive decline.In clinical work,patients should be actively evaluated for cognitive function,especially for patients with white matter lesions on imaging,in order to find their recognition early,intervene in time and intervene its risk factors.2 Patients with chronic cerebral circulation insufficiency secondary to cognitive impairment have abnormal brain material metabolism,and the cognitive function of patients with chronic cerebral circulation insufficiency is related to abnormal material metabolism,which has certain guiding significance for early diagnosis of CCCI secondary to cognitive impairment and guiding clinical treatment.