Assessing Global Cognitive Function In Patients With Vascular Cognitive Impairment Through Structural Magneto Resonance Imaging And Vascular Risk Factors

Objective This project is based on the association among pathology of cerebral vascular injury in vascular cognitive impairment(VCI),neuropsychological scales,and the characters of magnetic resonance imaging(MRI)varying from different patterns and levels of vascular injury of brain,take patients with vascular cognitive impairment as the object of study subject investigated,take demographic factors,vascular risk factors together with structural magnetic resonance imaging(sMRI)indexes which might be associated with cognitive function as independent variables,referring to current diagnosis and neuropsychological evaluation criteria for VCI and vascular dementia(VaD),to obtain the weight reflecting how different types and different levels of ischemic injury contribute to cognitive impairment,and to establish a model to assess cognitive function.Methods This project is a retrospective cross-sectional population-based study.167 individuals(91 male V.S.76 female,54.5%:45.5%)were admitted in this study,age ranged from 40 to 90 years old(mean 69.15y,SD=10.231,median = 71 y),each of the participants had more than one vascular risk factor.The general information were recorded including gender,age,and years of education;medical history related to Framingham Stroke Risk Profile(FSRP)including hypertension,anti-hypertension therapies,diabetes mellitus type2,atrial fibrillation,cardiovascular disease,left ventricular hypertrophy,together with history of smoking.Calculate the risk score of each participant.Carry out the structural MRI scan with SIEMENS 3.0T magnetic resonance imaging machine(Magneto Trio,Erlangen,Germany),the sequences includes sagittal and horizontal position of T1 sequences,horizontal position of T2 and T2-FLAIR sequence,and DWI sequence.Record the following indexes:global cortical atrophy scale(GCA-scale),medial temporal atrophy scale(MTA-scale),and Fazekas scale which reflects the severity of white matter lesions.Measure the total volume of strategy regions of infarcts including left angular gyrus,inferomesial temporal,mesial frontal,anterior and dorsomedial thalamus,left capsular genu,and caudate nuclei.Count the number of lacunar infarcts.Assess cognitive function by taking mini-mental status examination(MMSE),Take MMSE scores as The dependent variable,other indexes as independent variables,create a matrix(167x8).Screen those indexes with significant linear relationship and calculate the weight(rn)with MATLAB 7.6.0.324(R2008a).Result In this multiple regressive model for patients under the condition of vascular cognitive impairment,the level of their cognition function is associated with the following indexes:years of education(r=5.557,p=0.000<0.01),Framingham stroke risk prifile(r=-11.471,p=0.000<0.01),severity of global cortical atrophy(r=-2.051,p=0.042<0.05),severity of medial temporal lobe atrophy(r=-2.019,p=0.045<0.05),severity of white matter lesions(r=-2.046,p=0.042<0.01)and total volume of strategy region infarcts(r=-3.860,p=0.000<0.01)including left angular gyrus,inferomesial temporal,mesial frontal lobe,anterior and dorsomedial thalamus,capsular genu,and caudate nuclei.Quantity of lacunar infarcts has no significant linear correlation.Conclusion For patients under the condition of vascular cognitive impairment,it is reasonable to estimate the cognitive level via the following formula:b = 23.982-3.191*Xi-2.886*X2-2.187*X3 + 5.339*X4-12.364*X5,where Y representing cognition,the value equivalents to mini-mental status examination(MMSE);Xi representing strategy region infarcts,the value is total amount multiplied by total volume;X2 representing global cortical atrophy(GCA);X3 representing white matter lesions(Fazekas scale);X4 representing education,the unit is year;X5 representing Framingham Stroke Risk Profile,the unit is%.The accuracy is 65.2%in back-substitution validation and 66.7%in empirical analysis.