Correlation Of Enlarged Perivascular Spaces And Post-Stroke Cognitive Impairment In Patients With Acute Mild Stroke

Objective:To investigate the relations between enlarged perivascular spaces(EPVS)and poststroke cognitive impairment(PSCI)in patients with acute mild ischemic stroke.Methods:A total of 259 patients with acute mild ischemic stroke who were hospitalized in the Department of Neurology,Qingdao University Affiliated Hospital from October 2019 to June 2021.Collect patients’ demographic data,risk factors for cerebrovascular disease,laboratory test results,imaging examinations,neuropsychological assessments and other data.At the same time,the EPVS severity grading of MRI was performed,and the possible influencing factors affecting the EPVS of the basal ganglia and the centrum semiovale were respectively investigated.Mo CA was used to assess the cognitive function of the enrolled patients within 48 hours of admission(baseline),30 days after stroke,and 90 days after stroke.According to the score of 90 days after stroke,they were divided into cognitive impairment group and normal cognitive function group.The clinical data and imaging data of patients from the 2 groups were compared.Analysis to determine independent influencing factors of PSCI.Spearman correlation analysis was performed to analyze the correlations of severity degrees of EPVS of basal ganglia with Mo CA total scores and each cognitive domain scores in patients from cognitive impairment group.Results:A total of 234 patients completed the follow-up with complete data,the results are as follows:(1)The incidence of cognitive impairment was different in different periods after acute ischemic stroke.Within 48 hours of admission(baseline),30 days after stroke,and 90 days after stroke,the incidence of cognitive impairment was 57.5%,50.4% and 49.1%respectively.(2)The different severity of EPVS in the basal ganglia and EPVS in the central semiovale were compared in the enrolled patients.The results showed that the severity of EPVS in the basal ganglia was related to hypertension,WMH grading,lacunar and MOCA score,and the difference was statistically significant(P<0.05).The severity of EPVS in the central semiovale was related to WMH grading,and the difference was statistically significant(P<0.05).(3)Statistical analysis was performed on the two groups with or without cognitive impairment.The results showed that cognitive impairment was related to age,years of education,diabetes,frontal lobe infarction,basal ganglia EPVS,WMH grading,and CMB,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that age,years of education,diabetes,frontal lobe infarction,and basal ganglia EPVS were independent influencing factors of cognitive impairment 90 days after mild stroke.Correlation analysis showed that the severity degrees of basal ganglia EPVS were negatively correlated with Mo CA scores,and scores of visual space and executive ability scale,attention scale,language scale and delayed recall scale(P<0.05).Conclusion:Hypertension,WMH grading,lacunar,MOCA score were associated with the severity of EPVS in the basal ganglia,The WMH grading was associated with the severity of EPVS in the central semiovale.Basal ganglia EPVS is an independent risk factor for cognitive dysfunction in patients with mild ischemic stroke.The main cognitive domains affected are visual space and executive ability,attention,language,and delayed recall.Therefore,the basal ganglia EPVS can be used as an imaging marker of PSCI,which has important clinical significance for clinicians to assess the cognitive function and prognosis of stroke patients early.