Correlation Study Between Enlarged Perivascular Space And Executive Function In Patients With Recent Small Subcortical Infarct

Objective : To identify the influencing factors for cognitive impairment in patients with recent small subcortical infarct(RSSI),and explore the relationship between enlarged perivascular space(EPVS)and executive function in patients with RSSI.Methods : From February to December 2021,a total of 115 patients with first onset RSSI admitted to the Changzhou Second People’s Hospital were collected.Baseline clinical profile and imaging data were collected after admission.Clinical baseline data included age,sex,years of education,body mass index(BMI),history of disease(hypertension and diabetes),vascular risk factors(smoking and drinking history),glycosylated hemoglobin,fasting glucose,total cholesterol,triglycerides,low density lipoprotein cholesterol,high density lipoprotein cholesterol,homocysteine,uric acid,creatinine and urea nitrogen.Imaging data included T1-weighted imaging(T1WI),T2-weighted imaging(T2WI),diffusion weighted imaging(DWI),fluid attenuated inversion recovery(FLAIR),and magnetically sensitive weighted imaging(SWI)sequences for cranial Magnetic resonance imaging(MRI).Improve patient neuropsychological scale assessments,including the Montreal Cognitive Assessment scale(Mo CA),Stroop Color and Word Tests(SCWT)and Trail Making Test(TMT).According to Mo CA scores,these patients were divided into normal cognitive function group(Mo CA scores≥26,n=45)and cognitive impairment group(Mo CA scores<26,n=70).The volume and visual classification of EPVS in basal ganglia(BG)and centrum semiovale(CSO)of the two groups were evaluated.Univariate analysis was used to analyze the differences of general clinical data and EPVS volume between the two groups;multivariate Logistic regression analysis was used to identify the independent influencing factors for RSSI combined with cognitive impairment.Patients were further divided into EPVS non-mild group and EPVS moderate-severe group according to EPVS visual assessment;the differences of scores of different executive function domains were compared between the two groups;Spearman correlation analysis was used to observe the relationships of EPVS grading and volume with executive function.Results : Among 115 patients with RSSI,patients in the cognitive impairment group had significantly older age,significantly higher serum creatinine level,proportion of patients with moderate severe basal ganglia EPVS(BGEPVS)and BG-EPVS volume,and significantly lower years of education as compared with those in the normal cognitive function group(P<0.05).Multivariate Logistic regression analysis showed that BG-EPVS volume(OR=1.421,95%CI: 1.028-1.965,P=0.034)was an independent risk factor for RSSI combined with cognitive impairment.Mo CA total scores,scores of visual space and executive function domains in patients of the BG-EPVS moderate-severe group were significantly lower than those in patients of the BG-EPVS non-mild group,while Z-scores of Stroop color word test(SCWT)and trail making test(TMT),and total Z-scores of executive function were significantly higher than those in patients of the BG-EPVS non-mild group(P<0.05).SCWT test card C time,card C error number,card C-card B time,card C-card B error number,card C-card A time,card C-card A error number were significantly higher than BG-EPVS non-mild group.In TMT test,the first minute arrival number of patients with moderate and severe BG-EPVS was lower than that of patients of BG-EPVS non-mild group,and the number of errors and prompts,and the average time of TMT-A and TMT-B were higher than those of patients of BG-EPVS non-mild group(P<0.05).Spearman correlation analysis showed that BG-EPVS grading and volume were positively correlated with total Z-scores of executive function in RSSI patients with cognitive impairment(r=0.439,P=0.001;r=0.410,P=0.001).Conclusion : BG-EPVS volume is an independent risk factor for cognitive impairment,and both BG-EPVS grading and BG-EPVS volume are correlated with impairment degrees of executive function in cognitive function in RSSI patients.