The Study For Cognitive Function Impairment And Risk Factor In Patients With Chronic Cerebral Circulation Insufficiency

Background and Objective:Chronic cerebral circulation insufficiency (CCCI) was put forward first by Janpnese scholars in 1990 and it basically was proposed for old or pre-elderly patients clinically with repeated complaint of dizziness, headache, head-heavy and other subjective symptoms, but no nerve damage and no signs of craniocerebral computed tomography (CT) abnormalities besides fundus oculi atherosclerosis. And the Janpnese scholars also protocolled the standard of the diagnosis in 1991.The research about chronic cerebral hypoperfusion caused cognitive impairment is very much in the foundation, but very little in the clinical research. And the clinical research more detect with MMSE scale. The Montreal cognitive assessment (MoCA) is proposed newly that have more sensitive to the mild cognitive impairment (MCI) and vascular cognitive impairment (VCI). Through the MoCA scale and MMSE scale neuropsychological detection, this study analyze the rate of CCCI patients occurs cognitive impairment and the characteristics of their neuropsychological detection.This study also analyze the relationship between the cognitive impairment and CCCI risk factors, so as to pay attention to the CCCI early cognitive impairment. And through the contrast with the MMSE and MoCA scale and the characteristics of the MoCA scale neuropsychology, we want to accumulate material that contribute to the CCCI early screening of cognitive function . To look for further risk factors, thus to improve the control risk factors and delay the cognitive impairment occurs.Methods:In this study, we selected 63 cases CCCI patients in neurology ward and outpatient service as case group and 55 cases the normal people over the age of 45 in neurology outpatient service and physical examination center in the first hospital of jilin university as control group from May 2009 to March 2010. For each group of patients we collected detail history and the symptoms of patient, signs, name, sex, age, education level, smoking history, alcohol history, history of hypertension, history of diabetes, history of heart disease and blood pressure, blood glucose and intracranial and extracranial vascular examination (TCD, carotid arteries color ultrasound examination,craniocerebral MRA or CTA), and craniocerebral imaging (CT or MRI) results, then simultaneously detected the MoCA and MMSE scale, and Hamilton depression rating scale (HDRS).Then the patients of all the case group and control group were assigned to congtive impairment group and non-cognitive impairment group according to the scores of MoCA≥26 or MoCA<26. At last,we analyzed all the data by SPSS 17.0 statistical software.Results:The results were as follows:①The congtive impairment detection rate of MoCA scales 61% was more than MMSE scales 16.9% in all of case group and control group. The detection rate of two test methods comparisons showed significant difference (P<0.01). Meanwhile, the congtive impairment detection rate of MoCA scales 77.8% was more than MMSE scales 30.2% in case group. The detection rate of two test methods comparisons showed significant difference (P<0.01). We made the ROC curve of MoCA every scores in mild or severe cognitive impairment with the standard of scores of MMSE below 25 in patients which the scores of MoCA below 26.We found the cutoff is 21 scores which the sensitivity and specificity is 90% and 92.3%.②The scores of MoCA had significant positive correlation with MMSE, Rs = 0.813 (P<0.01). The MoCA scores became higher, so the MMSE scores became higher.③In case group, contrasting to the patients of non-cognitive impairment group (MoCA≥26), the patients of cognitive impairment group (MoCA<26) had lower scores in every cognitive areas, especially in spaces executive function, language skills, denomination, abstract thinking and delayed recall, and the difference was significant (P<0.01). The patients with cognitive impairment in case group had lower MoCA scores in spaces executive function, language skills and delayed recall than in control group. The two group comparisons showed difference (P<0.05).④Analyzing the risk factors of case group patients with cognitive impairment, we concluded the following results. The cognitive impairment group have no difference with the non-cognitive impairment group in the following aspects (P>0.05). It was men or women, with a history of smoking or no smoking, with a history of drinking or no drinking, diabetes or no diabetes, hypertension or no hypertension, heart disease or no heart disease. In the age, two group showed difference (P<0.05). The cognitive impairment group was older than non-cognitive impairment group. In education degree more than 12 years or no more than 12 years, two group showed difference (P<0.05). The cognitive impairment group had lower educated year than non-cognitive impairment group. In the cerebral imaging with without symptoms lacunar infarction or mild white matter lesion or normal, two group showed difference (P<0.05). The cognitive impairment group which had without symptoms lacunar infarction or mild white matter lesion was more than non-cognitive impairment group. In cerebral blood flow abnormality or intracranial and extracranial angiostenosis to normal cerebral blood flow and intracranial and extracranial vessel only the different degree of atherosclerosis, two group showed difference (P<0.05). The cognitive impairment group which had cerebral blood flow abnormality or intracranial and extracranial angiostenosis was more than non-cognitive impairment group.Conclusion:①CCCI patients of early stage have varying degrees cognitive impairment. MoCA scale have high detection sensitivity of cognitive impairment above MMSE scale. It can be found that the missing part of the MMSE scale. And the scores of MoCA have positive correlated with MMSE scale. The patients which MoCA scale as the screening scale of MCI detect abnormal aren't always mild cognitive impairment. We think the 21 scores of MoCA is probably the cutoff which distinguish the mild and severe cognitive impairment.②The cognitive impairment of CCCI patients show the cognitive areas in spaces executive function, language skills, denomination, abstract thinking and delayed recall.③The decline of cognitive areas in spaces executive function, language skills and delayed recall may be characteristic presents of CCCI patients cognitive impairment.④Advanced age, low education degree, cerebral imaging with without symptoms lacunar infarction or mild white matter lesions and cerebral blood flow abnormality or intracranial and extracranial angiostenosis can increase the CCCI patients occuring cognitive impairment. It is risk factors of CCCI cognitive impairment, and the high education degree is the protective factors.⑤CCCI is a chronic latent ischemic cerebrovascular disease. Clinical doctors and patients are both easy to ignore it. Early detection and early prevention CCCI risk factors is useful to improve and delay the cognitive impairment and related diseases such as Bingswanger, ischemic stroke.