Study On The Relationship Between White Matter Lesions Of Vascular Origin And Cognitive Impairment

Objective White matter lesions(WMHs)and lacunar infarctions(LIs)are the typical Magnetic Resonance Imaging(MRI)representations of cerebral small vessel disease(CSVD).Along with speedy increase of the aged population and the development of neuroimaging technique,the incidence of WMLs is higher,but the relationship between WMLs and cognitive impairment is still not clear.This research adopted Wisconsin White Matter Hyperintensities Segmentation Toolbox(W2MHS)to auto extract and mark white matter lesions and calculate the volume of WMLs in different areas.The characteristics of cognitive function in patients with WMLs in different extents and different locations will be investigated.Besides,the characteristics of cognitive function in the patients with both WML and LI will be studied.Expecting to raise awareness of WML-related cognitive impairment for persons in related fields and provide theoretical basis for early clinical prevention and treatment.Methods This study recruited continuously the patients over age 50 who met the inclusion criteria in the department of Neurology of Affliated Drum Tower Hospital of Nanjing University Medical School from January 2017 to December 2017,which recruited 125 patients with WML,57 patients with WML-LI and 30 healthy subjects in control group.The related risk factors such as age,sex and other clinical data were collected.Brain MRI and neuropsychological tests were conducted.This study adopted W2 MHS to auto extract and mark white matter lesions and calculate the volume of WMLs based on 3D T1WI(Three-dimensional T1 weighted imaging,3D T1WI)and 3D FLAIR(Three-dimensional Fluid attenuated inversion recovery,3D FLAIR).The patients were divided into three groups according to WML volume: WML-mild group with 42 subjects,WML-moderate group with 42 subjects and WML-severe group with 41 subjects.Then according to the location of WMLs,the patients in the WML group were divided into periventricular lesions(PVL)group with 41 cases and deep white matter lesions(DWML)group with 39 cases.Next,the effect on the cognition function of the WML-LI and the different extents and locations of the WMLs were evaluated.Result Compared with the normal control group,patients in moderate and severe WML groups were older and higher blood homocysteine,the difference has statistics meaning(P<0.05).There was a positive correlation between the severity of WML and the prevalence of cognitive impairment.The prevalence of cognitive impairment in mild,moderate and severe WML groups were 45.23%,59.52% and 73.17% respectively,and there was statistically significant difference(P=0.035)after adjustment for age.There was significant difference in the time of TMT-B(Trail making test B,TMT-B)and the scores of language between mild WML group and normal control group(P < 0.05)after adjustment for age.In addition,there was significant difference in the time of TMT-A,TMT-B and the scores of the language among moderate,severe WML group and normal control group(P < 0.05).The scores of language,calculation were significantly lower in periventricular lesions group than in control group,while the time of TMT-A,TMT-B were significantly longer(P<0.05).In the deep white matter lesions group,only the scores of calculation was significantly lower than the normal control group.Compared with the normal control group,the scores of total Mo CA,abstract thinking and language were lower in the WML-LI groups,while the time of TMT-A,TMT-B and Stroop C were longer,there was statistically significant difference(P < 0.05).There was significant difference in the scores of abstract thinking between WML group and WML-LI group(P < 0.05).Conclusion: 1.Degree of cerebral white matter lesions associated with age and blood homocysteine;2.WMLs were positively associated with the prevalence and the degrees of cognitive impairment,WMLs mainly damage the executive and language functions;3.Different locations of WMLs have different influence on cognitive domains,compared with the deep white matter lesions,the periventricular lesions has more effects on cognition,especially on executive function.4.The language function,abstract thinking and executive function were impaired in patients with both WML and LI,but only the scores of abstract thinking had significant difference between the WML group and WML-LI group.