Analysis Of Neuropsychological Tests In Patients With Cerebral Microbleeds

Background:Cerebral microbleeds(CMBs)is a type of brain parenchymal damage characterized by chronic hemorrhage due to small vascular injury(diameter<200?m).It used to be thought that CMBs had no clinical symptoms.With the development of imaging technology,especially the application of T2*GRE and SWI,more and more CMBs lesions have been detected and earned much attention.Intensively studies suggest CMBs not only cause physical dysfunction,cognitive decline,and mental illness,but also increase the risk of stroke,dementia,and even death.The relationship between CMBs and cognitive function has been one of research hotspot.The past studies often use single cognitive function assessment,such as mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA).Few studies apply comprehensive neuropsychological tests to analyze cognitive status in patients with CMBs.Objective:A variety of neuropsychological tests were used to analyze the characteristics of cognitive function in patients with CMBs.Method:We collected 61 subjects who were hospitalized in the department of neurology of Jinan central hospital during September 2019 and January 2020.All subjects were divided into two groups,CMBs positive group(31 cases)and CMBs negative group(30 cases).According to the CMBs anatomical site,we divided CMBs positive subjects into strictly lobe group,deep or infratentorial group.According to the number of CMBs,all subjects were divided into level 0,1,2 and 3.Gender,age,history of hypertension,history of coronary heart disease,history of diabetes,history of stroke,history of smoking,history of drinking,and systolic and diastolic blood pressure level was recorded in detail.Within 24 hours after admission,relevant laboratory examinations(including fasting blood glucose,glycosylated hemoglobin,triglycerides,total cholesterol,LDL cholesterol,HDL cholesterol,homocysteine)and brain magnetic resonance imaging(MRI)were completed.All subjects complete the Montreal cognitive assessment(MoCA),trail making test(TMT),symbol digital modalities test(SDMT),verbal fluency test(VFT),digit span test(DST),Rey auditory verbal learning test(RAVLT),Rey-Osterrieth complex figure test(ROCFT).The risk factors of CMBs and cognitive impairment characteristics of patients with CMBs were analyzedResults:1.General information comparisonThe age,history of hypertension,systolic blood pressure level is associated with CMBs(P<0.05).The gender,history of coronary heart disease,history of diabetes,history of stroke,history of smoking or drinking,and diastolic blood pressure levels are not associated with CMBs(P>0.05)2.Comparison between the CMBs positive group and CMBs negative groupCompared with the CMBs negative group,the CMBs positive group were significantly lower in the scores of MoCA total scores,visuospatial and executive,delayed recall(P<0.05)and there was no significant difference in the scores of naming,attention,language,abstraction and orientation between two groups(P>0.05)In testing of different cognitive domains,the scores of CMBs positive group in the SDMT,DST forward recitation,DST backward recitation,DST total scores,ROCFT copy,RAVLT immediate memory,RAVLT delayed recall were significantly lower(P<0.05)than CMBs negative group.The results of TMT time-consuming,phonemic VFT,semantic VFT,VFT total scores had no significant difference between two groups(P>0.05).3.The effects of CMBs in different location on cognitive functionCompared with CMBs negative group,the strictly lobe group had significantly lower scores in MoCA total scores,DST backward recitation,DST total scores,ROCFT copy,RAVLT delayed recall,the difference was statistically significant(P<0.05);the deep or infratentorial group had significantly lower scores in MoCA total scores,SDMT scores,DST backward recitation,DST total scores,ROCFT copy,RAVLT delayed recall,the difference was statistically significant(P<0.05)4.The association of CMBs number with cognitive functionAccording to the number of CMBs,all subjects were divided into levels 0,1,2 and 3.The results showed that the number of CMBs was negatively correlated with the total score of MoCA scale,and the difference was statistically significant(P<0.05)Conclusion:1.CMBs is associated with age,hypertension,systolic blood pressure level2.CMBs can affect the cognitive function,including the global function,attention/executive function,visuospatial function and memory function;the number of CMBs is associated with cognition impairment3.CMBs in both lobe area and deep or infratentorial area are associated with decline in global function,attention/executive function,visuospatial function and memory function4.For the CMBs population without dementia or the subjective complaint of cognitive impairment,the application of the global cognitive function assessment(e.g.MMSE,MoCA)combined with the relevant cognitive subfacies test may be more effectively to assess the cognitive function and determine whether there is cognitive impairment.