Correlation Between Carotid Atherosclerosis And Post-Stroke Cognitive Impairment In Patients With Mild Ischemic Stroke

Objectives:To investigate the correlation between carotid atherosclerotic indexes and the development of post-stroke cognitive impairment(PSCI)in patients with mild acute ischemic stroke(AIS),and to assess the prevalence of PSCI and its risk factors after 6 months in patients with mild AIS for better early identification and early diagnosis of patients with PSCI.Methods:From October 2020 to October 2022,181 patients with mild AIS were enrolled in the First Bethune Hospital of Jilin University,181 of them completed the study and followed up after 6 months.After 6 months,AIS patients were divided into PSCI group and PSNCI group according to Mo CA score.PSCI was defined as Mo CA score < 22 points.The following demographic and clinical variables were compared between the two groups: demographic data,serologic measures,carotid atherosclerosis measures,neuropsychological scores,and magnetic resonance imaging(MRI)data.Binary logistic regression and receiver operating characteristic(ROC)curve were used to evaluate the predictive value of carotid atherosclerosis indicators and their combination with different independent influencing factors for PSCI.Results:1.A total of 181 patients with mild AIS were included in this study,including 75 in the PSCI group,accounting for 41.4%,and 106 in the PSNCI group,accounting for 58.6%.There were 135 males(74.6%),with an average age of 62.34±7.60 years and an average of 12 years of education.The prevalence of PSCI at 6 months after AIS was 41.4%,which was significantly lower than that in patients with acute cognitive impairment(51.9%).2.There were significant differences between the two groups in previous history of stroke,history of hypertension,carotid plaque Crouse score,years of education,triglyceride,WMH,intima-media thickness of the right common carotid artery,degree of common carotid artery stenosis,MMSE,Mo CA,CDR,and ADL(P<0.05).3.In logistic regression,carotid plaque Crouse score(OR=1.153,95% CI:1.063-1.251)and severe common carotid artery stenosis(OR=3.532,95%CI: 1.635-7.632).predicted an increased risk of PSCI.4.Multivariable analysis of PSCI occurrence: In the multivariable analysis incorporating carotid plaque Crouse score and degree of common carotid artery stenosis,carotid plaque Crouse score,severe common carotid artery stenosis,history of previous hypertension,history of previous stroke,and severe WMH were independent risk factors for the occurrence of PSCI,and years of education was an independent protective factor for PSCI.Among them,history of previous hypertension and history of previous stroke as categorical variables were independent risk factors for PSCI,common carotid artery stenosis and WMH as grade variables were independent risk factors for PSCI,carotid plaque Crouse score as a continuous numerical variable was an independent risk factor for PSCI,and years of education as a continuous numerical variable was an independent protective factor for PSCI.5.The sensitivity and specificity of carotid plaque Crouse score and common carotid artery stenosis to predict PSCI were relatively low,with an AUC of 0.667(95% CI: 0.589-0.745)for carotid plaque Crouse score and 0.596(95% CI: 0.589-0.750)for common carotid artery stenosis,but when combined with age,years of education,previous hypertension,previous stroke history,WMH years of education,history of previous hypertension,history of previous stroke,and WMH were combined,the PSCI prediction model yielded an AUC of 0.818(95% CI: 0.758-0.877)for area under the curve,and the area under the curve and sensitivity of the diagnostic model were substantially improved.6.The mean scores of AVLT-I,AVLT-II,VFT,TMT-B and CDT were different between PSCI patients and PSNCI patients at 6 months(P<0.001).For patients with PSCI,compared with baseline at 6 months,AVLT-I was significantly improved(baseline 9.58±4.49 vs.June 12.06±8.05,P<0.001),AVLT-II was significantly improved(baseline 3.58±2.45 vs.June 4.10±2.71,P<0.001),and VFT was significantly improved(baseline 31.82± 10.70 vs 34.70±8.43 in June,P<0.001),while their TMT-B and CDT remained stable.7.Mo CA subdomain scores were different for both PSCI and PSNCI patients at 6 months(P< 0.05).For PSCI patients,they had significantly better orientation(baseline 4.68 ± 1.43 vs.June 4.92 ± 1.34,P=0.014),significantly better reading knock(baseline 0.57 ± 0.50 vs.June 0.72 ± 0.45,P=0.042),significantly better calculation(baseline 1.64 ± 1.05 vs.June 1.85 ±0.92,P=0.003),and worsened naming,abstraction,and language skills,while their visuospatial,attention,and delayed recall remained stable.Conclusions:1.Carotid plaque Crouse score,history of previous hypertension,low years of education,severe common carotid artery stenosis,history of previous stroke,and severe WMH were all independent risk factors for the development of PSCI at 6 months in patients with AIS.2.The carotid plaque Crouse score and the degree of common carotid artery stenosis can be combined with age,years of education,history of previous hypertension,history of previous stroke and WMH to improve the diagnostic value of PSCI.3.Mean scores for AVLT-I,AVLT-II,VFT,TMT-B,and CDT differed between PSCI and PSNCI patients at 6 months;Mo CA subdomains included visuospatial,naming,attention,reading knock,calculation,language,abstraction,delayed recall,and orientation,all of which differed significantly between PSCI and PSNCI patients at 6 months.