Clinical Study On Enlarged Perivascular Space In Centrum Semiovale In Alzheimer''s Disease

Objective: MRI was used to assess the severity of EPVS in centrum semiovale in Alzheimer's Disease(AD)patients and older adults with normal cognitive function,so as to explore the impact of EPVS in centrum semiovale on cognitive function and the relationship between EPVS in centrum semiovale and the risk of AD.Methods: 1.A total of 94 AD patients admitted to the department of neurology of Dalian Medical University from March 2014 to December 2018 were selected as the AD group,and 87 older adults with normal cognitive function who came to our hospital for physical examination during the same period were selected as the control group.There was no relationship between the two groups of patients.2.In AD group,MMSE and MoCA were used for neuropsychological assessment,and ADL was used for daily life assessment.In the control group,MMSE was used for neuropsychological assessment,and HAMA and HAMD were used for emotional state assessment.3.People in both groups underwent head scanning by 3.0T MRI,and WMHs and EPVS were evaluated by T2-weighted?FLAIR sequence imaging.EPVS in centrum semiovale were coded with the following scale applied to standard axial images:0=no EPVS,1=1 to 10 EPVS,2=11 to 20 EPVS,3=21 to 40 EPVS,and 4?40 EPVS.Grade 0-1 was mild EPVS,grade 2 was moderate EPVS,and grade 3-4 was severe EPVS.A rating scale was used to describe the different types of hyperintense signal abnormalities surrounding the ventricles and in the deep white matter.PWVHs were graded as 0 = absence,1 = “caps” or pencil-thin lining,2 = smooth “halo,” 3 = irregular PWVHs extending into the deep white matter.DWMHs were rated as 0 = absence,1 = punctate foci,2 = beginning confluence of foci,3 = large confluent areas.Grade 1 was mild WMHs,grade 2 was moderate WMHs,and grade 3 was severe WMHs.4.SPSS 23.0 was used for statistical analysis of all data,and the significance level was p=0.05.Result: 1.General information: there was no significant difference between AD group and control group in age,gender,smoking,drinking,education background,hypertension,diabetes,LDL-C,TG,TC,HDL-C,HCY(all p values were > 0.05).The difference in MMSE score between AD group and control group was statistically significant(p < 0.0001).2.Comparison between the AD group and the control group in EPVS,PWMHs and DWMHs: EPVS: The AD group had the highest proportion of grade 2,while the control group had the highest proportion of grade 1.The difference between the AD group and the control group was statistically significant(p < 0.0001).PWMHs: Both the proportion of grade 1 in the AD group and the control group was the highest,and there was no significant difference in PWMHs between the AD group and the control group(p=0.39).DWMHs: The proportion of grade 0 in the AD group was the highest,while the proportion of grade 1 in the control group was the highest.There was no significant difference in DWMHs between the AD group and the control group(p =0.36).3.The relationship of EPVS and cognitive function in AD group : The severity of the EPVS was no significant correlation with MMSE score(p = 0.17).According to the score of MMSE,AD was divided into three groups: mild,moderate and severe.Correlation analysis showed that the MMSE score of moderate AD and severe AD was negatively correlated with the severity of EPVS(moderate AD: ?=-0.36,p =0.017.Severe AD: ?=-0.59,p=0.005),the more severe EPVS was,the lower MMSE score was.The MMSE score of mild AD was not correlated with the severity of EPVS(p =0.77).The severity of EPVS was negatively correlated with MoCA(?=-0.17,p = 0.01).The more severe EPVS were,the lower the MoCA score was.The severity of EPVS was positively correlated with the ADL score(?=0.44,p < 0.0001).The more severe EPVS was,the higher the ADL score was.4.The relationship between EPVS and AD risk: EPVS had a significant impact on the risk of AD(P < 0.0001).The more severe EPVS was,the higher risk of AD was.Compared with mild EPVS,OR=4.44(95%CI: 1.57-12.57)for moderate EPVS and 23.41(95%CI: 5.73-95.66)for severe EPVS.Other confounding factors were adjusted(including PWMHs,DWMHs,age,gender,smoking,drinking,education,hypertension,diabetes,LDL-C,TG,TC,HDL-C,HCY).After adjustment for smoking,OR value and 95%CI were increased slightly(> 15%).After adjustment for other confounding factors,OR value and 95%CI were not significantly changed(less than 15%).Conclusion: 1.The number and severity of EPVS in centrum semiovale in AD patients was significantly higher than that in control group.2.There was a negative correlation between EPVS and cognitive function in centrum semiovale in AD patients.The more severe the EPVS was,the more significant the cognitive decline was,especially in moderate and severe AD patients.3.After controlling for other confounders,EPVS was significantly correlated with the risk of AD.EPVS was maybe an independent positive predictor of AD incidence.