| AimThe correlation between the plasma Hcy level and the cognitive function of patients with subcortical ischemic disease(SIVD)was investigated through the detection of their plasma homocysteine(Hcy)level and neuropsychological scores.Materials and MethodsA total of 130 patients with SIVD,including 73 males and 57 females,who visited The department of Neurology ofShandong Provincial Hospital and Shandong Dongying Shengli Hospital from May 2016 to May 2017 were selected,with an average age of 70.26±8.68 years and a course of disease ranging from 2.5 to 7.5 years,with an average length of 5.16 ± 2.88 years.According to the diagnostic criteria,SIVD patients were divided into two groups:subvascular mild cognitive impairment(SVMCI)group and subvascular dementia(SVaD)group.Among them,72 patients with SVMCI were 68.42±9.96 years old,and 58 patients with SVaD were 71.42 ±5.78 years old.A total of 60 elderly people of the same age and sex who underwent physical examination during the same period were selected as control group.To collect all the participants were the general clinical data,including patient age,cultural level,gender,history of diabetes and high blood pressure in patients with history,whether drinking and smoking,etc.),collected all the subjects' routine biochemical indicators,including liver function index aspartate aminotransferase,aspartate aminotransferase,AST),alanine aminotransferase,alanine aminotransferase,ALT),creatinine kidney function indicators,Cholesterol level,high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),triglyceride(TG),and total serum cholesterol(TC).Blood was collected intravenously on an empty stomach and the plasma Hcy level was detected with the Hcy test kit.Folic acid and vitamin B12 levels were respectively detected with the automatic chemiluminescence immunoanalyzer to compare the differences of plasma Hcy,folic acid and vitamin B12 levels between different groups.A total of 5 neuropsychological scales were selected to evaluate all the subjects.The scales used were the Montreal Cognitive Assessment(MoCA)Scale,mini-Mental State Examination(MMSE)Scale and Hamilton Depression Scale.The HAMD scale,Activity of Daily Living(ADL)scale and Clinical Dementia Rating(CDR)scale were used to analyze the differences of MoCA scores in various cognitive domains of each group,and multiple linear regression analysis was conducted for the risk factors that may cause cognitive impairment of SIVD patients.Results1.Comparison of baseline data between SVMCI patients,SVaD patients and control groupThere were no statistically significant differences in the basic clinical data of patients in the control group,SVMCI group and SVaD group,such as gender,age,history of smoking and alcohol,ALT,AST,creatinine,blood glucose,TC,TG,HDL-C,LDL-C,etc.(P>0.05).There were statistically significant differences in the incidence of hypertension and diabetes(P<0.05).2.Comparison of plasma Hcy levels,VitB12 and FA between SVaD group and SVMCI group and control groupAccording to the statistical analysis of the data,(1)Plasma Hcy levels in SVaD group and SVMCI group were significantly higher than those in the control group,and SVaD group was higher than SVMCI group,with statistically significant differences(P1<0.001;P2<0.001;P3<0.001);(2)The folic acid level of SVaD group and SVMCI group was significantly lower than that of the control group,and SVaD group was lower than that of SVMCI group,with statistically significant differences(P1<0.001;P2<0.001;P3<0.05);(3)Vit B12 level of SVaD group and SVMCI group was lower than that of the control group,and SVaD group was lower than that of SVMCI group,the difference was statistically significant(P1<0.001;P2<0.001;P3<0.05).3.Comparison of overall neuropsychological scale scores between SVaD group,SVMCI group and control groupThe SCORES of CDR,ADL and HAMD in SVaD group and SVMCI group were all higher than those in the control group,while MMSE and MoCA scores in VaD group and SVMCI group were all lower than those in the control group,with statistically significant differences(P<0.001).4.Comparison of MoCA scores in various cognitive domains between SVaD group,SVMCI group and control groupThe MoCA scale scores of the SVaD group,the SVMCI group and the control group were compared in various cognitive fields.It was found that:(1)the SVaD group scored lower than the control group in seven fields,including visual space and executive ability,naming,attention,language,abstract thinking,delayed memory,and orientation,and the differences were statistically significant(P<0.001).(2)The SVMCI group scored lower than the control group in visual space and executive ability,attention,abstract thinking and delayed memory,and higher than the control group in naming,language and orientation,with statistically significant differences(P<0.001).5.Multiple linear regression analysis may be associated with cognitive impairment in patients with SIVDAfter adjusting for the influence of other influencing factors,age,years of education,MoCA score and Hcy level,folic acid level,vitamin B12 level,diabetes mellitus,hypertension,MMSE score,CDR score,ADL score,HAMD score and other related risk factors were analyzed.Multiple linear regression results showed that systolic blood pressure,blood glucose level and plasma Hcy level were correlated with MoCA score(P<0.05).Systolic blood pressure was negatively correlated with MoCA score,while blood glucose level and plasma Hcy level were positively correlated with MoCA score.ConclusionThere was a significant correlation between the cognitive function of SIVD patients and the level of Hcy in plasma.By analyzing the plasma Hcy level,the cognitive impairment of SIVD patients can be recognized at an early stage and effective intervention measures can be proposed as early as possible,which is conducive to the effective delay of the cognitive impairment.Hcy may be an effective potential intervention target for the treatment of impaired cognitive function in patients with SIVD. |
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