Relationship Between Cognitive Impairment And TOAST Subtypes With Ischemic Stroke

Objective To study the relationship between cognitive impairment and Large-artery Atheroscl erosis(LAA) stroke, Small-artery Occlusion(SAO) stroke, and to compare the damage of cogniti ve areas of the two subtypes, analyzing the correlation between neurological impairment and cog nitive impairment.Methods The study population consisted of 150 cases of patients with acute ischemic stroke who were hospitalized in the Department of Neurology of the Second Hospital of Lanzhou Uni versity between October 2014 to October 2015. All patients were classified by TOAST classificat ion according to the results of brain MRI、MRA、Carotid Duplex Ultrasound、TCD、Cardiac Co lor Ultrasound、ECG、DSA and so on. Patients with LAA stroke and SAO stroke were selected as case group. Thirty cases of individuals at the same period in our hospital outpatient examined were included as control group. National Institute of Health Stroke Scale(NIHSS) was used to evaluate the neurological impairment of case group.Mini-Menta1 State Examination(MMSE) and Montreal Cognitive Assessment(Mo CA) were used to evaluate the cognitive function, recording t heir scores in all cognitive areas, analyzing the correlation between neurological impairment and cognitive impairment.Results 1. A total of 150 patients with acute ischemic stroke were enrolled. The most frequ ent stroke subtype was Small-artery Occlusion(SAO)(59, 39.3%), followed by the stroke of Lar ge Artery Atherosclerosis(LAA)(38, 25.3%). 2. The rate of cognitive impairment of SAO was 66.1%, and that of LAA was 44.7%, there was statistical difference between the two groups(P<0.05). 3. The MMSE scores of LAA and SAO were 23.4±5.4,25.6±2.6; The Mo CA scores were 22.1±5.7,22.3±3.6, there was statistical difference between the two groups(P<0.05), The MMSE sc ores and Mo CA scores of control group were 28.3±1.4, 26.0±1.9, the difference between case gr oup and the control group was statistical(P<0.05). The MMSE scores of LAA were lower than those of SAO, there was statistical difference between the two groups(P<0.05); The Mo CA score s of LAA were lower than those of SAO, there was no statistical difference between the two gr oups(P>0.05). 4. In LAA group the areas such as language function、abstract thinking、delayed memory ability、orientation were mainly impaired. Visual spatial and executive function、attention、abstract thinking were mainly impaired in SAO group. There was statistical difference of scores in visual spatial and executive function、attention and delayed memory ability between the two gr oups(P<0.05). 5. The scores of NIHSS were negatively correlated with the scores of MMSE an d Mo CA(r=-0.506,-0.293, P<0.05).Conclusions 1.The LAA and SAO subtypes of ischemic stroke can lead to cognitive impair ment. 2. The rate of cognitive impairment of SAO is higher than LAA subtype. 3. SAO has mil d cognitive impairment, only parts of the cognitive function are impaired, mainly in visual spatial and executive function、attention、abstract thinking.; LAA subtype has severe cognitive impairme nt and almost all areas of cognitive function are impaired, mainly in language function、abstract t hinking、delayed memory ability、orientation. 4. The heavier the neurological impairment, the hea vier cognitive impairment.