Influence Of White Matter Lesions On Earlier Cognitive Impairment In Patients With Mild Acute Ischemic Stroke

Objective: With the improvement and widespread application of neuroimaging technology,cerebral white matter lesions detection rate is increasingly higher in middle-aged and old people.Recent studies have found that WMLs is not only an image presentation of cerebral small vessel disease,but often coexists with other geriatric diseases(such as Alzheirmer disease,Parkinson disease and stroke).Despite most studies show that WMLs could increase the risk of ischemic stroke patients' poor prognosis in short-term and long-term,the effect of WMLs on early cognitive function in patients with mild ischemic stroke is still controversial currently.We prospectively evaluate 156 patients' early cognitive function status and explore WMLs whether or not affects early cognitive function.Besides we can make prediction about cognitive dysfunction in timely,take effective prevention and treatment,and improve cognitive function and promote recovery to the greatest extent,and reduce disability and recurrence of ischemic stroke.Methods: Demographic data,vascular risk factors,and clinical and imaging faetures in 237 patients with acute ischemic stroke,prospectively were registered from September 2016 to September 2018 consecutive patients.According to inclusion and exclusion criteria,156 cases of mild stroke patients(NIHSS?5)were recruited finally.The severity of WMLs were assessed by Fazekas visual semiquantitative scale and age-related white matter changes(ARWMC)scale.Cognitive function was assessed with MMSE and MoCA.We divided the patients into normal cognitive group and cognitive dysfunction group according to the threshold 25/26 and 21/22 respectively and compared the total WMLs loads(Fazekas and ARWMC)between the two groups.Non-white matter lesions group included 49 cases,mild white matter lesions group 77 cases and severe white matter lesions group 30 cases according to Fazekas scale;mild white matter lesions group included 76 cases,moderate white matter lesions group 46 cases and severe white matter lesions group 34 cases according to ARWMC scale.The effects of WMLs with different severity on earlier cognitive function in patients with mild acute ischemic stroke were statistically analyzed.Results: There were 156 patients with acute mild ischemic stroke,85 with normal cognitive function and 71 with cognitive impairment.WMLs scores were 1(0,1)and 2(1,2)in cognitive normal group and cognitive impairment group according to Fazekas scale and there was a significant difference between two groups(P value<0.05).WMLs scores were 3(2,6)and 5(2,8)in terms of ARWMC scale in the two groups respectively and there was also a significant difference(P value<0.05).There was statistical difference in WM of the frontal lobe between the two groups,although there was no statistical difference WM in the parieto-occipital lobe and temporal lobe.156 patients were divided into 3 groups according to the Fazekas scale: no WMLs(49 cases),mild to moderate WMLs(77 cases)and severe WMLs(30 cases).The total scores of MMSE and MoCA in the 3 groups were not consistent(P value<0.01).There were not completely similar among the 3 levels of WMLs in the orientation function and language function measured by MMSE(P value<0.05).In the three groups of WMLs with different degrees,visuospatial and executive function,directional and abstract thinking ability measured by MoCA were different(P value<0.05).156 patients were divided into mild WMLs group(84 cases),moderate WMLs group(48 cases),and severe WMLs group(24 cases)according to ARWMC scale.The total scores of MMSE and MoCA were not exactly same in the different severity of WMLs(P value<0.01).Language function assessed by MMSE were not completely equal in the three groups(P value<0.05).There were not all the same in visuospatial executive function and abstract thinking function assessed by MoCA among 3 groups(P value<0.05).Conclusion: WMLs is more severe in the earlier cognitive impairment patients with acute ischemic stroke and frontal white matter lesions may affects cognitive function;different severity WMLs has effect on general cognitive function in patients with ischemic stroke,mainly on the orientation and language ability assessed by MMSE,as well as the visuospatial executive function and abstract thinking assessed by MoCA.