The Neuropsychological Profile Of Cognitive Impairment In Subcortical Single Stroke

Background:Vascular cognitive impairment(VCI) has been of great interest to researchers because it is common,costly,and possibly preventable.The cognitive profiles after stroke in different lesions have still been explored.With the increased awareness of dementia accompanied by multiple sclerosis and parkinson's disease,subcortical structures have been presumed to participate the formation of cognitive function,while cortex was deemed to be the unique participant in the past. The study of cognitive profile in subcortical single stroke is rare,although it is the common type of stroke.The Montreal Cognitive Assessment(MoCA) has been used on a wide scale in assessing VCI recently,but still disputed.Objective:The aim of this study is to investigate the neuropsychological profile of cognitive impairment in subcortical single stroke,presume the cognitive function of subcortical structures,and approach the rationality of MoCA assessing these patients.Methods:A sample of 33 consecutive patients(26 of ischemia,7 of hemorrhage;12 of left lesions,19 of right lesions,2 of both sides;16 of stroke in thalumus,8 of stroke in basal ganglia district,9 of stroke in paraventricular white matter) with subcortical single stroke,aged 50—80 years,was investigated using neuropsychological examination covering global cognitive function,executive function,memory function,language function and visual spatial skills.These patients were compared to normal contral subjects(n=20).Result:(1) Cognitive performance of the patients was inferior to that of the normal control group throughout all domains.(2) Compared to controls,patients with left lesions performed worse in language function,response inhibition,speed and accuracy of mental processing,immediate listening memory,listening recognition,logical delayed memory and working memory,while patients with right lesions performed worse in spatial skill,speed of mental processing,immediate listening memory,logical delayed memory and visual spatial memory.patients with both sides lesions performed worse in language function,accuracy of mental processing,immediate listening memory,logical delayed memory,visual spatial memory and working memory.The difference between left and right lesion groups was damaged verbal fluency.(3) Compared to controls,group of thalamus stroke performed worse in immediate and delayed listening memory,listening recognition, logical delayed memory,speed of mental processing,response inhibition and language function.Group of stroke in basal ganglia district performed worse in immediate and delayed listening memory,logical delayed memory,viasual spatial memory,speed of mental processing,set shifting,language function and space perception.Group of stroke in paraventricular white matter performed worse in short time listening memory,speed and accuracy of mental processing,language function, space perception.The difference among these three groups was damaged immediate logical memory only,the goup of stroke in paraventricular white matter performed better than the other two groups.Conclusion:(1) All cognitive domains may be involved in VCI with subcortical single stroke.However;the cognitive pattern is different due to different lesions, which may be explained by the connection of cortical and subcortical fibres.(2)There is lateralization in subcortical structures.Left subcortical structures control language function,while the rights control spatial skill.(3)MoCA has its limit in assessing cognitive impairment after subcortical single stroke.Maybe we need classified assessment in VCI.