Effects Of The Total MRI Burden Of Cerebral Small Vessel Disease On Cognitive Impairment In Patients With Minor Stroke

Objective: The aim of this study was to investigate the effects of the total MRI burden of cerebral small vessel disease(CSVD)on cognitive impairment in patients with minor stroke and establish a theoretical foundation for early recognition,diagnosis and delaying vascular cognitive impairment in minor stroke.Methods: A total of 221 patients with minor stroke admitted to the Department of Neurology,Qingdao University Affiliated Hospital from October 2017 to September 2019 were enrolled in the study.Demographic data(age,gender,years of education),risk factors of cerebral vascular disease(hypertension,diabetes,hyperlipidemia,coronary heart disease,smoking,drinking and so on)and laboratory examination(blood glucose,triglycerides,serum total cholesterol,low density lipoprotein cholesterol and so on)were collected.The MRI was performed within 7 days of admission,“the total CSVD score”(combining the MRI feature of lacune,WMH,CMB and PVS)was used to represent the total MRI burden of CSVD.MOCA scores were used to evaluate cognitive levels at admission,1 month and 3 months after onset.All the enrolled patients were divided into five groups including CSVD0,CSVD1,CSVD2,CSVD3 and CSVD4.The logistic regression analysis was used to screen the independent risk factors of the total CSVD score and cognitive impairment after minor stroke.The linear regression model was used to analyze the correlation between the total CSVD score and the MOCA score and subitems,meanwhile,evaluate the predictive value of the distribution characteristics of each CSVD on the cognitive impairment.Results: A total of 209 patients with minor stroke were included and successfully followed up according to the inclusion and exclusion criteria.(1)Statistical analysis of the clinical data among the five groups showed that there was significant difference in age,hypertension,MOCA score at baseline,1 month and 3 months after onset(P<0.05).(2)Spearman rank correlation analysis showed that age,MOCA score at baseline,1 month and 3 months after onset were positively correlated with the total CSVD score(P<0.05).(3)Statistical analysis of clinical data between cognitive impairment group and non-cognitive impairment group showed that there was significant difference in age,years of education,cortical infarction,number of CMB,number of lacune,number of basal ganglia PVS,WMH Fazekas scores and the total CSVD score(P<0.05),multivariate logistic regression analysis showed that education level,number of basal ganglia PVS,WMH Fazekas scores and the the total CSVD score were independent risk factors for cognitive impairment in 3 months after minor stroke.(4)linear regression model analysis showed that the total CSVD score was significantly correlated with MOCA score,visual space and executive function,attention and memory(P<0.05).the total CSVD score could explain 69.5% of the cognitive decline after minor stroke,the degree of explanation was higher than single CSVD.(5)In 1 month after minor stroke,both WMH Fazekas score and the total CSVD score were negatively correlated with cognitive improvement(P<0.05),years of education was positively correlated with cognitive improvement(P<0.05).In 3month of minor stroke,only the total CSVD score is negatively correlated with cognitive improvement(P<0.05).Conclusion:(1)the total MRI burden of CSVD is an independent risk factor for cognitive impairment in patients with minor stroke,which mainly affects visual space and executive function,attention and memory.(2)The predictive value of the total MRI burden of CSVD on cognitive decline in patients with minor stroke was significantly higher than that of single CSVD.(3)Cognitive impairment occurs in patients with minor stroke in the acute phase and improves over time,the total MRI burden of CSVD is an independent risk factor for no cognitive improvement after minor stroke.