Analysis Of Risk Factors,imaging Features And Correlation Of Cognitive Dysfunction In Senile Ischemic Cerebrovascular Disease

Background: With the advances in medical technology and the improvement of people’s living conditions,the average life span in China has been significantly increased,accompanied by the aging of the population process is also intensified,the health of the elderly get more attention,and stroke is becoming more common in older people.Stroke severely affects the lives of older people,and cerebral small vessel disease(cerebral small vessel disease,CSVD)leads to neurological loss,disability and cognitive impairment,which increases the burden on the family and society.CSVD has attracted much attention due to its high morbidity and its role as the main reason of vascular cognitive impairment(VCI),which is one of the hot spots of cerebrovascular disease.CSVD is usually insidiously onset,slowly developing.Due to the lack of specific clinical manifestations,CSVD has not attracted enough attention.The incidence of CSVD is positively correlated with age.In the elderly population,lacunar cerebral infarction,subcortical white matter lesions such as white matter osteoporosis and cerebral microinfarction caused by CSVD,especially ischemic CSVD,are the primary causes of cognitive dysfunction and functional loss in the elderly.Therefore,in recent years,the study of ischemic CSVD has become a hot spot,and the relevant diagnosis and treatment guidelines of CSVD have been formulated in China.The correlation between various risk factors leading to atherosclerosis,such as age,hypertension,diabetes,dyslipidemia,and the imaging changes of CSVD and the cognitive impairment of ischemic CSVD in the elderly,still needs further study.The research of risk factors of CSVD and its controllable factors for cognitive impairment and clinical intervention may be helpful to prevent cognitive impairment caused by CSVD.Objective:To explore the risk factors of ischemic cerebrovascular disease,and to evaluate the cognitive function of elderly patients with ischemic cerebrovascular disease,and to research the risk factors,imaging characteristics and correlation between the cognitive dysfunction caused by cerebrovascular disease and cognitive dysfunction.To provide reference for improving the clinical level of early recognition and diagnosis of senile ischemic CSVD.Methods:The data of 187 elderly patients(≥60 years old)with ischemic cerebrovascular disease(CSVD)confirmed by craniocerebral MRI were collected.In addition,30 elderly patients with cerebral MRI without CSVD imaging changes,including leukoaraiosis and lacunar infarction,no history of cerebral hemorrhage or traumatic brain injury,and normal cognitive function were selected as the control group.The cognitive function of the patients was evaluated according to the Montreal Cognitive Assessment Scale(Mo CA),and the scores of each area of cognitive function were recorded in detail.The patients enrolled are divided into the following groups:1.normal control group(NC group): Mo CA score ≥26,healthy elderly people with no cognitive impairment,and brain MRI examination without ischemic CSVD imaging changes,30 cases;2.Ischemic CSVD group(187 cases):(1)Ischemic CSVD group with normal cognitive function(CSVDN group): Mo CA score ≥26 points,31 cases;(2)ischemic CSVD cognitive impairment group(156 cases):(1)ischemic CSVD vascular cognitive impairment of none dementia group(VCIND group): 18 ≤ Mo CA score < 26,90 cases;(2)vascular dementia group(VD group): Mo CA score < 18,66 cases.The general information,age,education years and vascular risk factors of all enrolled patients are collected and analyzed.The risk factors of ischemic cerebrovascular disease are analyzed by univariate analysis and multiple logistic regression analysis.Univariate analysis and multiple logistic regression analysis are performed on the factors of cognitive decline in patients with ischemic microvascular disease.Results:1.Ischemic cerebral small group compared with control group,single factor analysis results show that age,education years,hypertension,coronary heart disease,low-density lipoprotein cholesterol(LDL-C),Hyerhomocysteinemia(HHCY),smoking,internal medial thickness(CIMT),carotid plaque index,and carotid stenosis are associated with ischemic cerebral vascular disease.The results of multiple logistic regression analysis show that advanced age,hypertension,high level of LDL-C,incrassated CIMT are risk factors of CSVD(P < 0.05).Compared with VD group,the results of single factor analysis show that hypertension,LDL-C,HHCY,smoking,drinking,CIMT,carotid plaque index,carotid stenosis are related to vascular cognitive impairment(VCI).(P < 0.05).The results of multiple logistic regression analysis show that risk factors of vascular cognitive impairment were less educated and high level of LDL-C(P < 0.05).2.Leukoaraiosis(LA)is significantly associated with carotid artery stenosis and carotid plaque index,patients with carotid artery stenosis are more likely to have white matter osteoporosis,the higher the carotid plaque index was,the more severe the white matter osteoporosis would be.Compared with the CSVDN group in ischemic cerebrovascular disease,the results of MRI show that the VCIND group gets worse periventricular leukoaraiosis(LA)and leukoaraiosis(LA)in deep brain,higher Fazekas score and number of lacunar infarction(LI)which are statistically significant(P < 0.05).It is found statistically significant that the more lesions of small brain vessels,the more serious the degree of cognitive impairment(P < 0.05).3.The Mo CA evaluation results showed that the cognitive dysfunction of the patients decreased in visual spatial and executive function,naming,attention,computational power,abstract thinking,delayed recall,orientation and other aspects.Conclusion: Advanced age,hypertension,high level of LDL-C and incrassated CIMT were risk factors for cerebrovascular disease,while less educated and high level of LDL-C were risk factors for vascular cognitive impairment in ischemic cerebrovascular disease.Leukoaraiosis(LA)is significantly associated with carotid artery stenosis and carotid plaque index,patients with carotid artery stenosis are more likely to have white matter osteoporosis,the higher the carotid plaque index was,the more severe the white matter osteoporosis would be.The more severe the cerebral white matter osteoporosis and the more lacunar infarct lesions,the more obvious the cognitive dysfunction.Cognitive impairment is manifested in visual-spatial and executive function,naming,attention,computation,abstract thinking,delayed recall,orientation and other aspects.