Associations Of White Matter Hyperintensities With Executive Dysfunction:A Pilot Study

Objective: This study will assess the executive function of patients with white matter hyperintensity(WMH)in the flair sequence of cranial MRI using the Fazekas intuitive rating scale and neuropsychological scales(executive function scoring area of the Mo CA test,clock drawing test,Connections A and B,and Stroop color word test).The aim of this study is to investigate the correlation between different levels of white matter hyperintensity and executive dysfunction,to identify it early,to delay its deterioration and to prevent executive and cognitive decline,and to improve the quality of life of patients.Methods: 1.143 patients,including 66 males and 77 females,who underwent cranial magnetic resonance imaging(MRI)during their hospitalization in the Department of Neurology of Taizhou People’s Hospital from October 2019 to January 2021 were collected.Two specialist imaging physicians grouped the cranial MRI images using the Fazekas intuitive scoring scale(FLAIR sequence was chosen)with a scale score of 0 to6.A score of 0 meant 37 cases in the control group,43 cases in the 1 to 2 group were mild,32 cases in the 3 to 4 group were moderate and 31 cases in the 5 to 6 group were severe,with higher scores indicating more severe cerebral white matter lesions.The following neuropsychological scales were completed by 2 specialist neurologists trained in psychological rating tests for the control and experimental groups(mild,moderate and severe):(1)Mo CA test for overall cognitive function assessment with selected areas of executive function scores;(2)Clock Drawing Test(CDT);(3)Connecting the Dots Test A and B(TMT);(4)Stroop Color Word Test;(5)Clinical Dementia Rating Scale(CDR);(6)Activities of Daily Living Scale(ADL);(7)Hamilton Depression Inventory(HAMA);(8)Self-Assessment Scale for Anxiety(SAS).The lower the scores on the executive function scoring area and the clock drawing test on the Mo CA test the greater the impairment in executive function,while the longer the Connections Test A,B and the Stroop colour word test took the greater the impairment in executive function.2.Forty-six patients were selected and regrouped according to the criteria of paraventricular or deep white matter score of 0: the deep white matter score of 0 was divided into 23 cases in the paraventricular group;the paraventricular score of 0 was divided into 23 cases in the deep white matter group,comparing which part of the executive function was more impaired in the paraventricular or deep white matter.Statistical analysis was done using spss26.0.Results: 1.There were no significant differences in the comparison of baseline data of sex,diastolic blood pressure,glycosylated haemoglobin,cholesterol and triglycerides between the control and experimental groups(mild,moderate and severe)as classified by the Fazekas intuitive rating scale(P > 0.05),while there were statistically significant differences in the comparison of age,years of education and systolic blood pressure(P< 0.05);2.After controlling for age,years of education and systolic blood pressure,there was a statistically significant difference(p < 0.05)in the time taken(in seconds)to compare the scores of the Mo CA test in the executive function area and the clock test,as well as the Connections A,Connections B,Connections B-A and the Stroop colour word test,for different severity of cerebral white matter hypersignal;3.No statistically significant differences(p > 0.05)in the baseline data of age,sex,years of education,systolic blood pressure,diastolic blood pressure,glycated haemoglobin,cholesterol and triglycerides between the two groups comparing the paraventricular and deep white matter after splitting the cerebral white matter high signal into two groups by site;4.Comparing the area of executive function scores in the Mo CA test for high signal in cerebral white matter,the scores on the clock drawing test,and the time taken for Connected Test B and Connected Test B-A between the two groups of paraventricular and deep white matter was statistically significant(p < 0.05),while the time taken for Connected Test A was not statistically significant(p > 0.05);5.The cerebral white matter high signal group was negatively correlated with scores on the Mo CA test in the executive function scoring area and the clock drawing test(CDT)when compared to the mild,moderate and severe groups based on different levels of grouping,and was positively correlated with time spent on the Connectedness Test A,Connectedness Test B,Connectedness Test B-A(TMT),Stroop Test Part A,Stroop Test Part B,and Stroop Test Part C.Conclusion: 1.The white matter hyperintensity lesion group has executive function obstacles;2.The higher the degree of white matter hyperintensity lesions,the more severe the relative impairment of executive dysfunction;3.Compared with the white matter hyperintensity paraventricular disease group,the executive function damage of the deep white matter disease group is more serious.