Impact Of Serum Adma Levels On Mild Cognitive Impairment In Patients With Subcortical Ischemic Vascular Disease

ObjectiveTo explore the serum levels of Asymmetrical dimethylarginine(ADMA)and its effect on the mild cognitive impairment in patients with subcortical ischemic vascular disease(SIVD).Methods116 SIVD patients were recruited from the Department of Neurology,Affliated Provincial Hospital of Anhui Medical University and divided into two subgroups including no-cognitive impairment(SNCI)with 53 subjects and vascular mild cognitive impairment group(SVaMCI)with 63 patients.58 participants who visited our hospital department of health science for a health sceening examination were recruited as control group with normal cognitive function.All subjects underwent head MRI scan to evaluate the severity of white matter lesions(WML)(Fazekas score)and the number of the lacunar infarcts.The cognitive functions were evaluated by mini-metal state examination(MMSE),trail making test-A(TMT-A),clock drawing test(CDT),instrumental activities of daily living(IADL),boston naming test(BNT),hopkins verbal learning test(HVLT).Medical history information of all participants was collected in detail,including history of hypertension,age,education,smoking history,drinking history,history of diabetes.Fasting blood glucose,high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),total cholesterol,triglycerides and other biochemical indicators were detected in all the subjects.Fasting elbow venous blood samples were collected from all subjects and serum ADMA levels were measured by enzyme-linked immunosorbent assay(ELISA).The levels of serum ADMA and the degree of brain injury(WML grade and the number of lacunar infarcts)were compared among the three groups.Multiple linear regression analysis and correlation analysis were used to explore the relationship of ADMA levels and cognitive function scores.Results(1)The proportions of hypertension and Fazekas scores in SIVD patients were significantly higher than control group(P<0.01);The educational years in SVaMCI group were lower than those in SNCI group and control group(P<0.05);The number of lacunar infarcts and the level of serum ADMA in SVaMCI group,SNCI group were significantly higher than those in control group,and the SVaMCI group was higher than that in SNCI group(P<0.01).(2)Correlation analysis showed that there was a positive correlation between serum ADMA level(rs=0.208,P<0.05)and Fazekas score and the number of lacunar infarcts(rs=0.416,P<0.01).(3)Binary Logistic analysis showed that both hypertension(OR=5.316,95%CI:2.573~10.983,P<0.01)and serum ADMA concentrations(OR=2.549,95%CI:1.155~5.626,P<0.05)were risk factors for SIVD.(4)The scores of MMSE,HVLT,BNT and CDT in SVaMCI group were significantly lower than those in SNCI group and control group(P<0.01).The scores of TMT-A and IADL scores in SVaMCI group were significantly higher than those in SNCI group and control group(P<0.05).(5)Correlation analysis showed that serum ADMA levels were significantly correlated with MMSE(r_s=-0.227,P<0.05),BNT(r_s=-0.245,P<0.05),CDT(r_s=-0.364,P<0.01)?HVLT(rs=-0.285,P<0.01)scores and there was a significant positive correlation with TMT-A scores(rs=0.293,P<0.01).(6)Multiple linear regression revealed that ADMA levels in SIVD patients remained the negative relation with MMSE scores after controlling risk factors(?=-0.219,P<0.05).However,after futher adjusting for the grade of WML,the relation displayed no statistic significance.Conclusions(1)Serum ADMA levels in patients with SIVD were significantly higher than those in normal controls.And it is an independent risk factor for SIVD.The level of ADMA was closely correlated with the severity of brain injury.ADMA may play an important role in the pathogenesis of SIVD.(2)The level of ADMA in control group,SNCI group and SVaMCI group increased in turn.After adjusting for gender,age,years of education,hypertension,diabetes and other related factors,serum ADMA in SIVD patients is strongly related to cognitive dysfunction in SIVD patients.cognitive impairmen resulting from ADMA might have close association with the white matter lesions.(3)In the future,it may be possible to help us identify early SIVD and SIVD mild cognitive impairments by measuring serum ADMA levels,and may have some value in judging the severity of the disease.