Correlation Study Of Total Imaging Load With Homocysteine Levels And Cognitive Function In Patients With Cerebral Small Vessel Disease

Objective To investigate the relationship between total imaging load and blood homocysteine(Hcy)levels and cognitive function in patients with cerebral small vessel disease(CSVD).Methods 321 patients with CSVD admitted to the Department of Neurology of Baotou Central Hospital from September 2019 to December 2022 were enrolled,All patients underwent serum Hcy levels,magnetic resonance imaging(MRI)of the head and cognitive function assessment.Demographic and clinical data were collected and the four MRI features of white matter hyperintensities(WMH),lacunar infarction(LI),cerebral microbleed(CMB)and enlarged perivascular spaces(EPVS)were assessed overall(range 0～4)according to the CSVD total load score.(The four MRI features,enlarged perivascular spaces(EPVS),were evaluated overall(range 0～4),0～2 is the low load group and 3～4 is the high load group.Patients’ cognitive function was assessed using neuropsychological scales.Cognitive function was measured by the Mini-mental State Examination(MMSE)and the Montreal Cognitive Assessment(MOCA),and the relationship between different CSVD load groups and total cognitive scores and cognitive function in each domain of the Mo CA was assessed.Results 1.A total of 321 patients with CSVD were included in this study,divided into200 cases in the low load group and 121 cases in the high load group,in which hypertension,diabetes,age,low density lipoprotein(LDL)and Hcy were significantly different in the two groups(P<0.05).2.Multi-factor logistic regression analysis showed that LDL(OR 1.615,95%CI 1.194～2.184)and Hcy(OR 1.030,95%CI 1.017～1.044)ere independent risk factors for high CSVD imaging load.3.LDL and Hcy were both predictive of CSVD imaging hyperload and the predictive power of Hcy was greater than that of LDL(AUC=0.735>0.623,p<0.05).4.There was no difference between the overall perception and each domain when the total load score was 1 and when the total load score was 0(P>0.05).The MMSE score at a total load score of 2 was less than the total load score of 0(17.17±6.51 vs.20.48±5.45,P<0.05)and the differences in the remaining indicators were not statistically significant.The MMSE score was less than the total load score when the total load score was 3(16.70±7.00 vs.20.48±5.45,P<0.05),the Mo CA score was less than the total load score(15.26±3.57 vs.17.17±6.51,P<0.05),the delayed recall was less than the total load score(2.57±1.56 vs.3.46±1.27,P<0.05),and the differences in the remaining indicators were not statistically significant.The MMSE score was less than the total load score of 0 for a total load score of 4(15.31±6.21 vs.20.48±5.45,P<0.05)and the Mo CA score was less than the total load score of 0(14.62±3.61 vs.17.77±3.31,P<0.05),delayed recall was scored as 0(2.29±1.29 vs.3.46±1.27,P<0.05)and orientation was scored as 0(3.57±1.51 vs.4.52±1.29,P<0.05),with no statistically significant differences in the remaining indicators.5.Spearman correlation analysis of total load scores with visuospatial,naming,attention and computation,language,abstraction,delayed recall,orientation,Mo CA scores and MMSE scores,The results showed no correlations between visuospatial,naming,attention and calculation,language,abstraction and total load scores(P>0.05);delayed recall(r=-0.292,P<0.001),orientation(r=-0.222,P<0.001),Mo CA scores(r=-0.301,P<0.001)and MMSE scores(r=-0.267,P<0.001)were negatively and significantly correlated with total load scores.Conclusion 1.Hcy is an independent risk factor for increased overall CSVD load;2.CSVD total load score associated with reduced cognitive function,with significant impairment in overall cognitive function and delayed recall and orientation;3.The impaired cognitive domains differed between patients with different CSVD total load scores,and as the CSVD total load score increased,the impaired cognitive domains also increased.