| Objectives : This study focus on the clinical,blood test and white matter damage characteristics of patients with cognitive impairment(CI)in the primary hospitals in ethnic minority areas of Western China.Based on Ki Woong Kim’s classification method of White Matter Lesions(WMLs),the associations between WMLs subtypes and cognitive impairment,impairment of cognitive domain,and serum indexes were analyzed.Based on the different characteristics of clinical,serology and atherosclerosis of CI in Han and Uyghur patients,we try to find the influencing factors of CI complicated white matter damage in different races.This study aims to provide a reference for the early prevention and treatment of cognitive impairment.Method: Patients with WMLs combined with cognitive dysfunction who were admitted to Shanghai Changhai Hospital and the First People’s Hospital of Kashgar from January 2016 to December 2018 were included in the study.The cognitive level of each patients was assessed by the Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment scale(MoCA).The level of peripheral venous blood homocysteine,fasting blood glucose,glycosylated hemoglobin,white blood cell count,red blood cell count,platelet count,hemoglobin concentration,cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein,high-sensitivity C-reactive protein(hCRP),urea nitrogen,creatinine,uric acid were examined.The carotid artery color Doppler ultrasound and head magnetic resonance examination(T1,T2,DWI and Flair sequence)were completed.Results: The first part of the results showed that the overall MMSE scores of different subtype Kim classification groups were different(p<0.05).The MMSE scores of the proximal ventricle group were higher than those of the proximal cortex group and deep group(p=0.005,p=0.032).Similarly,the overall difference in the total score of MoCA between different groups was statistically significant and the MoCA score of the proximal ventricle group was higher than that of the proximal cortex group(p=0.007,p=0.033).According to the severity of cognitive impairment,the patients were divided into mild cognitive impairment(MMSE≥21)group and moderate to severe cognitive impairment(MMSE<21)group.The composition of Kim subtype between the 2 groups of patients are different(p<0.05).There were no significant differences in age,gender,history of hypertension,history of diabetes and smoking history between the two groups.There was no significant difference in the level red blood cells,white blood cells,platelets,fasting blood glucose,high-sensitivity C-reactive protein,triglycerides,cholesterol,high-density lipoprotein,low-density lipoprotein,and homocysteine between the two groups(p>0.05).The urea nitrogen content of the patient was higher than that of the control group(p<0.05).After adjusting for the effect of urea nitrogen,logistic regression analysis showed that compared with deep white matter lesions,the risk of moderate to severe CI was lower in lateral ventricle and proximal ventricle white matter lesions(p<0.05).Analysis on the cognitive domain impairment of different WMLs subtypes found that the visual space/executive function cognitive domain impairment is more severe in patients with deep white matter lesions,while the attentional cognitive domain impairment in patients with near-ventricular white matter lesions is less.In addition,we found that the total score of MoCA in patients with cognitive dysfunction without carotid plaque was lower than that in patients with cognitive dysfunction with multiple carotid plaques(p<0.05).The second part of the research results showed that in Uyghur patients with cognitive impairment combined with WMLs,the proportion of patients with mild cognitive impairment(MMSE≥21 points)was significantly higher than that of Han people(p<0.05).Similarly,the proportion of patients with mild cognitive impairment with a MoCA higher than 18 in the Uighurs was significantly higher than that of the Han(p<0.05).In order to study the differences in risk factors and cognitive impairment of patients with the same degree of cognitive impairment among different ethnic groups,we used age and MoCA scores to match the two groups of patients to 1:1 and included them in the statistical analysis.Forty patients with cognitive dysfunction and WMLs in Han and Uyghur were included in the analysis respectively.The results showed that the proportion of hypertension,diabetes,and smoking in Uyghur patients was higher than that of Han patients(p<0.001,p=0.008,p<0.001).The serum indices analysis indicated that the blood TG content of Uyghur patients were significantly higher than that of the Han patients(p<0.05).The incidence of multiple carotid plaques in Uyghur patients was significantly higher than that in Han patients(p<0.05).A comparison of the cognitive domain impairment of the two groups of people found that compared with Han patients,Uyghur patients had less naming impairment and more delayed recall impairment(p=0.001,p=0.018).Conclusion: Different Kim subtypes of white matter damage in patients with cognitive dysfunction and WMLs have different effects on cognitive dysfunction.Deep WMLs impairment have more severe damage to cognitive function than patients with other subtypes of WMLs.Compared with deep white matter lesions,WMLs in the lateral ventricle and proximal ventricle have a lower risk of moderate to severe cognitive dysfunction.Patients with deep WMLs suffer from severe visual space/executive function cognitive domain impairment,while patients with proximal ventricular WMLs suffer from less attentional cognitive domain impairment.Kim classification,as an indicator of cognitive impairment and cognitive domain impairment in patients with cognitive dysfunction and WMLs,has simplicity,feasibility and practicality.Patients with cognitive dysfunction in Uighurs with WMLs are more common with mild cognitive dysfunction,and risk factors for atherosclerosis such as hypertension,diabetes,and smoking are significantly higher than those in Han,and the incidence of multiple carotid plaques is significantly higher than in Han.It indicated that the risk factors of atherosclerosis and the degree of atherosclerosis in Uyghur and Han nationality patients are not necessarily related to the severity of cognitive dysfunction,suggesting that the occurrence of cognitive dysfunction in Han nationality may have other causes,and further research is needed. |
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