| BackgroundWith the continuous improvement of medical technology,the longevity of the people has also been gradually extended.It is associated with that cognitive decline crowd team also has a tendency to gradually expand, which will seriously affect the quality of life of the patients and their families,and will increase the burden of families and society. By the aid of magnetic resonance imaging (MRI) technology, people have had a deeper understanding about small vessel disease (SVD). Resent studies have found that SVD had a positive effect on cognitive impairment (CI), and it has aroused people’s special attention.As we all known, careful nursing only slows down the progress of the disease when it has developed into dementia,while the course is irreversible. SVD mainly includes lacunar infarction (LI), cerebral microbleeds (CMBs) and leukoaraiosis (LA). Among them, how does CMBs make cognitive function decrease? Are there any measures to prevent it? And what is the specific pathogenesis? Compared with most researches based on the cross-section, the prospective study is still very few. So now, this article will analyze it by adopting the method of prospective study.PurposesBy comparing the patients in groups with multipoint evaluation, this thesis mainly studies the influence of CMBs on the cognitive function, and finds the risk factors for CMBs. So that people can prevent controllable risk factors, as far as possible to reduce the occurrence of CI, which can be more helpful for the clinical work.MethodsThe patients that came from clinic, ward of the Department of Internal Medicine-Neurology and MEC of our hospital were selected as cases during the year of 2013. According to the conditions of the selection and exclusion, CMBs group had 68 persons, as group A. According to the distribution of CMBs, group A was divided into three subgroups:Al:focus in the lobes or in the white matter under the lobes;A2:focus in the deep brain regions such as basal ganglia, thalamus, corpus callosum area, internal capsule, external capsule, the brain stem or cerebellum;A3:focus both in the lobes and the deep areas above.And there were 116 persons who had no focus by the MRI of brain, as group B.At the beginning, all patients were enrolled in the general information. And doctors collected the patients’s blood pressure, blood routine examination, blood glucose, blood lipid, homocysteine (HCY) and other datas when they were enrolled into the group, after 3 months, after 6 months and 12 months later. Among them, blood lipid included triglyceride (TG), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). The data of neck vascular ultrasound, electrocardiogram (ECG), brain MRI and susceptibility-weighted imaging (SWI) were also registered. And the mini mental state examination (MMSE), barthel index and glasgow coma scale (GCS) were used to assess all the subjects.After data acquisition, the results were processed by means of statistical analysis software SPSS 17.0. Measurement data were treated by univariance analysis,anova for repeated measurement and nonparametric test.And enumeration data were processed in the way of chi-square test. At the same time, the methods of Pearson correlation, Spearman correlation and Logistic regression were used to carry out regression analysis. It was set up that P< 0.05 so as to have statistical significance.Results1. The average educational level of MMSE low group was lower than that of MMSE normal group.In MMSE low group,the average age and the prevalence of hypertension, stroke were more higher,and the ratio of brain MRI with WMH, CMBs was higher than that of MMSE normal group (P< 0.05).2. The average age, male proportion of group A were higher than that of group B (P<0.05); The proportions of patients with history of hypertension, diabetes, stroke and antithrombotic drugs were higher than that of group B (P< 0.05); In group A the proportion with LI and severe WMH was higher than that of group B (P< 0.05).3.Through four times comparison between groups, we found that in group A2 and group A3, the average of total MMSE score and attention, calculation scores were lower than that of group B (P< 0.05). While the drawing ability of group A3 had significant differences with group B (P< 0.05). After 6 months,the language ability score of group Al was lower than that of group B. After 12 months, total MMSE score, attention and computing power, language ability, design structure drawing ability of group Al were lower than that of group B (P< 0.05).4. Within the group after 6 months, total MMSE scores and calculation and attention scores of group A2 and A3, and delayed recall score in group A2 were all less than that when patients into groups (P< 0.05). After 12 months, total MMSE score, attention and calculation, delayed recall scores all decreased significantly than the original scores.which exists in three subgroups of group A and group B, and the drawing ability of group A also descended obviously(P< 0.05).5. The resuts of Logistic regression analysis showed that age, sex, history of hypertension and stroke were the risk factors for CMBs.6. The number of CMBs was negatively related with total MMSE score (P< 0.001); Distribution of CMBs related to total MMSE score (P< 0.05); By lobes CMBs group to deep CMBs again to diffuse CMBs order, the total MMSE score average was on the decline.Conclusions1. Cognitive function in patients existing CMBs was damaged significantly, especially in patients with deep CMBs and diffuse CMBs. Among them, the attention and calculation, delayed memory, and drawing ability were lowed significantly. The language expression and execution were damaged obviously in lobes CMBs patients.2. People’s cognitive function were gradually decreased as time went on, which were reflected in the earliest the attention, computing power and delay memory loss, followed by drawing ability drops. CMBs could damage cognitive function. And the damage to the cognitive function in patients with deep CMBs and diffuse CMBs were faster than that only in the lobes CMBs patients.3. The greater age of patients, the greater risk of CMBs. The risk of CMBs in patients with a history of hypertension, cerebral apoplexy were larger than those patients with nolistory. And the risk of CMBs in men was more high than that in women.4. The more CMBs lesions, the more serious cognitive decline.Cognitive impairment in patients with diffuse CMBs was heaviest, followed by deep CMBs group, again for lobes CMBs. |
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