Association Between Cerebral Small Vessel Disease And Vascular Cognitive Impairment

Objective: Cerebral small vessel disease(CSVD) refers to a group of pathological condition that affect the small arteries, arterioles and venules caused by different reasons.The clinical manifestations of CSVD are characterized by static focal cerebral infarction(asymptomatic cerebral infarction), Lacunar syndrome, cognitive dysfunction and so on.The presences of CVSD on Magnetic Resonance Imaging include Lacunar infarction(LI), white matter lesion(WML),cerebral microbleeds(CMB) and Virchow-robin spaces(VRS).It is one quarter of all ischemic stroke, and may contribute to the developing of vascular cognitive impairment(VCI).As a main risk factor and reason of progressive cognitive decline after stroke.Scholars pay more attention to the relationship between CSVD and vascular cognitive impairment, as well as the risk factors of CSVD. It is urgent to control the risk factors positively and effectively earlier, and prevent and delay the vascular cognitive impairment caused by CSVD.In recent years, Different conclusions are drawn on the risk factors of CSVD, including Hypertension,blood pressure variability, Diabetes, Hyperlipidemia, Hyperhomocysteinemia, smoking,drinking and so on.But hypertension is the most common of them.The objective of this study was to explore the relationship between CVSD and cognitive impairment and discuss the risk factors of CSVD, decrease the recurrence and rehospitalization rate of the cardiovascular and cerebrovascular disease, and delay the cognitive impairment in patients with CSVD by actively control blood pressure.Methods: 60 patients who were diagnosed CSVD from March 2013 to December 2015 at Second Affiliated Hospital of He bei Medical University, Department of Neurology were enrolled in the study.General clinical data of all patients were recorded, including age,gender,height,weight,education years,previous medical history of hypertension, coronary heart disease and diabetes,history of smoking, history of drinking as well as family history of cerebrovascular disease and so on, collected biochemical information, electrocardiogram,carotid artery ultrasound,TCD,imaging data(including MRI+MRA+DWI+SWI),24 hour ambulatory blood pressure monitoring, MMSE and Mo CA score.These 60 patients with CVSD according to MR were divided into four groups:pure LI group(11 cases),both LI and WML group(21 cases),both LI and CMB group(13 cases),LI,WML and CMB group(15 cases).Compared with skull MR negative normal person which as a control group were analyzed. Then conduct follow-ups through telephone calls or outpatient services respectively on the first, the third and the twelfth month after they are chosen as objects, asking them their drug use situation, the level of the hypertension, as well as whether there is any occurrence of stroke.Make the blood pressure drop to 130-140/80-90 mm Hg by adjusting the dosage or switching to a different medication.Results:1 There are 60 patients satisfying requirements during this study and none of the patients lost to follow-up.The statistical analysis of all the cases are as follows : total 60 patients,(age 40-75, average57.57±7.47), including 32 males(age 40-68, average 55.47±7.41), and 28 females(age 42-75, average 59.96±6.90).the control group have 20 cases,(age46-73, average 56.05±7.02), including 11 males(age 47-73, average 56.55±7.54), and 9 females(age 46-66, average 55.45±6.75).each group in the general information of no significant differences(P>0.05),they are comparable.2 MMSE score in pure LI group,LI+WML group,LI+CMB group, LI+WML+CMB group and control group were respectively(26.82±1.83),(26.76±2.45),(26.77±2.77),(23.80±2.83),(29.20±0.83).Mo CA score were respectively(23.55±2.46),(20.95±1.99),(21.23±2.91),(18.00±2.45),(26.20±1.61), Mo CA and MMSE total score in each group are positive correlation(r = 0.915, P = 0.000; r = 0.677, P = 0.001; r = 0.893, P = 0.000;r = 0.871, P = 0.000; r = 0.572, P = 0.008),and a statistically significant differences(P < 0.05).there were no significant differences in pure LI group,LI+WML group and LI+CMB group(P > 0.05),but have significant differences with LI+WML+CMB group(P < 0.05).pure LI group,LI+WML group,LI+CMB group,LI+WML+CMB group have significant differences with control group in MMSE and Mo CA score(P < 0.05).3 Pure LI group,LI+WML group,LI+CMB group and LI+WML+CMB group had significant difference in the number of different cognitive event(P < 0.05).4 MMSE score have shown that time orientation,immediate memory, attention and calculation,short memory,object naming,reading comprehension, verbal exposition, picture description of LI+WML+CMB group are lower than control group(P < 0.05).5 LI+WML+CMB group and control group logistic regression: hypertension(P = 0.009,OR = 31.087) and diabetes(P = 0.049,OR = 16.849) are related to CVSD.6 Annual per capita episodes of stroke and coronary heart disease have significant difference by control blood pressure positively before and after(P < 0.05).Conclusion: Pure LI group,LI+WML group,LI+CMB group and LI+ WML+CMB group MMSE and Mo CA scores are positive correlation. Each grup can lead to cognitive impairment.Among the groups, LI+WML+CMB group is most obvious and mainly Mild cognitive dysfunction.Cerebral small vessel disease(CSVD) especially Lacunar infarction(LI),white matter lesion(WML)and cerebral microbleeds(CMB) exist at the same time can lead to cognitive impairment,which mainly show in time orientation,immediate memory, attention and calculation,short memory,object naming,reading comprehension,verbal exposition,picture description.hypertension and diabetes are the strongly associated with the CSVD which can lead to the vascular cognitive impairment. hypertension is an independent risk factor for CSVD,through positive and effective control of blood pressure can reduce the recurrence rate and hospitalization rate of CSVD and coronary heart disease(CHD).