Clinical Manifestation Of White Matter Lesions In Stroke Patients

[Background] The relationship between White Matter Lesions(WML) and Stroke subtypes is remained uncertain in stroke patients, either is the mechanism of WML-related cognition impairment. The etiological and clinical manifestations of periventricular white matter lesions (PVWML) and deep white matter lesions (DWML) are different and so we investigated the clinical manifestation of white matter lesions in different position within stroke patients.[Objectives] This study aimed to identify the clinical risk factors of WML in different positions and to investigate the relationship between WML position and stroke subtypes within ischemic stroke patients. By comparing both the score of WML in different position and Cholinergic Pathways Hyperintensities Scale(CHIPS) score with the cognition impair-ment of stroke patients, we aim to explore the role of cholinergic pathway lesions in vascular cognition impairment.[Methods] (1) The clinical data of 427 patients with acute cerebral infarction were ana-lyzed retrospectively. All the patients were devided into five subtype groups according to the modified Trial of Org10172 in Acute Stroke Treatment (TOAST) criteria. The WML extent was assessed on fluid-attenuated inversion recovery (FLAIR) imaging according to Fazekas scale and Schelten scale. All the major risk factors were analyzed among WML groups de-fined by Fazekas scale in different positions and put the candidate risk factors into multire-gression model to determine the independent risk factors of PVWML and DWML. The dis-tribution of Fazekas scores of different positions (PWML/DWML; regions in Schelten scale) were compared among modified TOAST groups.(2) 61 in-patient, middle-aged and elderly stroke individuals underwent brain MRI and MoCA examinations. The white matter lesion on fluid-attenuated inversion recovery MRI images was scored using the semiquatitative rating scale of Scheltens and CHIPS.27 of them were followed-up in 6 months after the first test.Spearman partial rank correlation coeffi-cients and standardized regression coefficients were calculated between WML scores and MoCA scores.[Results] (1) The average age of 421 patients were 62.99±10.68 years old ranging from 40 to 91 years old. The possible indenpendent risk factors of PVWML were age(OR=1.053, p<0.001), prior-stroke(OR=2.363, p=0.007) and hypertension(OR=1.612, p=0.031). Age (OR=1.053, p<0.001), prior-stroke(OR=2.244, p=0.010) and hypertension(OR=1.554, p=0.048) were also the possible independent risk factors for DWML. PVWML scores varied among modified TOAST groups(p=0.032). The Fazekas score of PVWML in SAO group ranked higher than LAA group((p=0.002) and that of DWML did the same(p=0.039).Among the regions in Schelten scale, scores in anterior-horn varied among different TOAST groups (p=0.003) and both CE(1.25±0.56) and SAO(1.22±0.62) group ranks higher than LAA (0.95±0.62) group(p<0.05). Scores in frontal lobe ranks higher in SAO group than in LAA (p<0.05). (2) WML burdens of the 61 patients(63.98±9.13,45-82years old) had negative correlation with baseline MoCA scores(p<0.05) and so did CHIPS scores(p<0.05). CHIPS and Schelten scores had negative correlation with visuospatial/executive, naming, attention and abstraction(p<0.05). Scores in anterior and posterior horn, parietal lobe and caudate pu-tamen had significant correlation with MoC A scores(p<0.05). The CHIPS scores of the 27 patients followed-up had positive correlation with decrease of MoC A scores(p<0.05) but not did it in total WML burdens(p<0.05). The decrease in attention had significant relationship with CHIPS scores(p<0.05).[Conclusion]Age, prior-stroke and hypertension are possible independent risk factors of both PVWML and DWML. PVWML enxent varies among different stroke subtypes while both PVWML and DWML are related to SAO subtype more than the other groups. Choliner-gic pathyway leisons play a possible role in vascular cognitive impairment which was proven in both baseline and follow-up data, especially by affecting attention function.