Ecological Executive Function Characteristics In Patients With White Matter Lesions And Its Influencing Factors

Objective: To investigate the ecological executive function characteristics in patients with white matter lesions(WML)and its influencing factors.Besides discussing the difference between normal control group and WML patients,we also analyzed the ecological executive dysfunction of WML patients with different severity and location of lesion.Methods: According to the admission criteria and exclusion criteria,70 patients were selected from the neurology outpatient clinic and ward of the Third People's Hospital of Bengbu from January 2016 to August 2016.All patients underwent MRI examination.After detailed collection of clinical data,43 patients were included in the white matter lesion group and 27 normal subjects were included in the control group according to the imaging features of high signal changes on T2 WI and FLAIR,and ISO or hypo signal changes on T1 WI.According to Fazekas grade 0-3 visual scoring method,WML group was divided into three groups according to the severity,including mild subgroup in 14 cases,moderate subgroup in 15 cases,severe subgroup in 14 cases.WML was divided into periventricular white matter lesions(PVL)subgroup of 23 cases and deep white matter lesions(DWML)subgroup of 20 cases.The WML group and the control group were assessed with the Behavior Rating Inventory of Executive Function-Adult Version(BRIEF-A).The differences of ecological executive function between the two groupsand the severity and location of white matter lesions in WML group were compared.Results: Compared with the control group,the scores of the total score(compare62.30±6.82 with 40.00±2.30)and factors including inhibition(compare 54.12±5.88 with43.89±3.79),conversion(compare 69.65±5.45 with 42.70±3.45),emotional control(compare 61.19±8.33 with 43.26±2.36),self-monitoring(compare 56.12±10.02 with 38.00±0.00)and other behavioral management index(BRI)and metacognitive index(MI)of task initiation(compare 62.02±8.37 with 39.56±1.81),working memory(compare 65.33±8.13 with 40.44±1.28),planning(compare 66.79±5.93 with41.41±2.17),task monitoring(compare 66.77±2.43 with 40.96±4.22)and organization(compare 60.72±7.41 with 41.67±2.91)were significantly higher in the white matter lesion group than in the normal control group(P<0.05).There were significant differences in total score and two-dimensional score among mild,moderate and severe leukoencephalopathy groups(P<0.05),and the overall single factor score in moderate and severe leukoencephalopathy group was higher than that in mild leukoencephalopathy group(P<0.05).The BRIEF-A score of deep white matter lesions was higher than that of paraventricular white matter lesions in total score,two-dimensional score and single factor score.The difference was statistically significant(P<0.05).They were showed by multiple linear regression analysis,the inhibition,emotional control,self-monitoring,MI,task initiation,working memory,planning,organization,total score were positively correlated with lesion severity.BRI was positively correlated with educational level and lesion severity,at the same time,it was negatively correlated with lesion site.Conclusions:(1)Patients with white matter lesions had different degrees of impairment in all aspects of ecological execution function than those in the normal group.(2)The severity of leukoencephalopathy leads to different degrees of ecological executive dysfunction.With the severity of leukoencephalopathy worsening,its ecological executive function declines more significantly,especially in moderate and severe lesions.(3)There may be differences in ecological executive dysfunction between deep white matter lesions and paraventricular white matter lesions.Patients with deep white matter lesions had more ecological executive dysfunction than those with periventricular white matter lesions.(4)Adult version of the executive function behavior assessment scale(BRIEF-A)is suitable for clinical evaluation of executive function,especially ecological aspects of patients with leukoencephalopathy.It is also conducive to early detection of executive dysfunction in patients with WML,and has a good clinical significance and social effect on early intervention.