Study On The Influencing Factors And Early Warning Of Cognitive Impairment In White Matter Lesions

Background:White matter lesions(WMLs)are the main nuclear magnetic manifestations of cerebral small vessel disease(CSVD).WMLs are gradually progressing and can cause cognitive impairment(CI).There is no specific treatment method for advanced CI,which greatly increases the social and individual economic burden.Early prevention of risk factors and early diagnosis by seeking methods are the keys to CI caused by WMLs.Objective:Part ?:(1)To analyze the risk factors related to CI caused by WMLs and WMLs,and provide evidence for early prevention.(2)Analyze the impact of WMLs on cognitive field.Part ?:The degree of WMLs,the relationship between the degree of WMLs and CI,the degree of WMLs in the early warning of CI were quantitatively analyzed.Methods:Part ?:(1)Eighty eight WMLs patients admitted to the fourth medical center of Chinese PLA General Hospital from June 2015 to June 2018 were assigned to the WMLs group,and 42 patients without WMLs admitted to hospital were assigned to control group.According to the presence or absence of CI,WMLs patients were divided into two subgroups,57 cases in the WMLs-CI group and 31 cases in the WMLs-NCI group.(2)To compare the age,gender,chronic medical history,blood lipid,blood glucose,uric acid,Hey and other laboratory indicators between WMLs group and control group,WMLs-CI group and WMLs-NCI group.Find out the risk factors of WMLs and WMLs-induced CI.(3)To compare the cognitive function of WMLs group and control group,WMLs-CI group and WMLs-NCI group.Part ?:(1)30 patients with WMLs were selected and the volume of WMLs was quantitatively measured by the combination of nuclear magnetic examination and computer software.(2)Measured the volume of WMLs manually,and analyze whether there are differences between the two methods for measuring the volume of WMLs.(3)Correlation analysis was performed between WMLs volume and cognitive function.(4)To analyze the WMLs volume and CI by ROC curve.Results:Part ?:(1)BMI values of WMLs group,as well as prevalence of atherosclerosis,diabetes,hypertension,hyperlipidemia,systolic blood pressure,diastolic blood pressure,uric acid,Hcy,triglycerides,high-sensitivity C-reactive protein(HCRP),fasting Blood glucose and glycated hemoglobin were significantly higher than the control group,and total cholesterol and high-density lipoprotein cholesterol were lower than the control group,and the difference was statistically significant(P<0.05),Multivariate unconditioned logistic regression analysis showed that HCRP,atherosclerosis,Hcy and fasting blood glucose were independent risk factors of WMLs.(2)The age of WMLs-CI group,as well as the prevalence of atherosclerosis,diabetes,hypertension,the incidence of periventricular WMLs and Fazekas score,Hcy,HCRP were higher than WMLs-NCI group.The difference was statistically significant(P<0.05).Multivariate unconditioned Logistic regression model showed that age,Hcy and HCRP were independent risk factors for CI caused by WMLs.(3)The WMLs group was lower than the control group,and the WMLs-CI group was lower than the WMLs-NCI group in MMSE total score and the recall ability,language ability,computational power,orientation power score of MMSE sub-item,MoCA total score and visual space and execution ability,language ability,delayed recall ability,attention and abstract force score of MoCA sub-items.The P300 inciubation period in WMLs group was higher than that in control groiup.The P300 incubation period in WMLs-CI grop was higher than that in WMLs-NCI group.The differences were statistically significant.Part ?:(1)The WMLs volume was quantitatively detected by software segmentation automatic measurement and manual measurement,and there was no statistically significant difference in the volume of WMLs measured by the two methods.(2)WMLs volume was positively correlated with P300 incubation period.It was negatively correlated with MMSE total score,computing ability,recall ability,structure imitation ability of MMSE sub-items,MoCA total scores,delayed recall ability,Visual space and execution ability,language ability,attention ability of MoCA sub-items.(3)ROC curve analysis showed that with 10.305cm3 as the cut-off point value,the sensitivity,specificity and area under the curve of white matter lesion volume in the diagnosis of WMLs patients with cognitive impairment was 78.9%,91%and 0.933,respectively.Conclusion:Part ?:(1)Risk factors for WMLs are common risk factors for cerebrovascular diseases,and independent risk factors include HCRP,atherosclerosis,Hcy and fasting blood glucose.(2)Independent risk factors for CI caused by WMLs include age,Hcy,HCRP.(3)CI caused by WMLs will affect visual space and executive ability,attention,language ability,abstract ability and delayed recall ability.Part ?:(1)WMLs volume was negatively correlated with cognitive funetion.(2)WMLs volume has certain diagnostic value for cognitive impairment.