The Risk Factors Of Cognitive Dysfunction And The Correlationship With Hemodynamics Of White Matter Lesions

Objective:To explore the risk factors of cognitive dysfunction in patients with white matter disease(WML),and to analyze the correlation between the degree of WML and cognitive impairment.Transcranial Doppler Ultrasound(TCD)was further used to investigate the relationship between intracranial hemodynamics and cognitive function in WML patients.Methods:A total of 156 consecutive inpatients with WML from the neurology department in Hebei General Hospital between May 2018 and May2020 were selected in our study,all of whom underwent neuropsychological scale score,cranial MRI and TCD examination.According to the Mini-Mental State Scale(MMSE)patients were divided into 51 cases in the cognitive normal(CN)group and 105cases in cognitive impairment(CI)group.The general data,blood biochemistry and imaging data were collected.Montreal cognitive assessment(Mo CA)was used to evaluate the individual cognitive function.TCD was used to evaluate the intracranial hemodynamics of the subjects.Statistical methods,such as t test,χ~2 test,Z test,logistic regression and Spearman’s correlation analysis were used to explore the risk factors and correlation of cognitive dysfunction in patients with WML.According to Fazekas the subjects were divided into A(mild 1-2 points),B(moderate 3-4points)and C(severe 5-6 points)groups.Spearman’s correlation analysis andχ~2 test were used to explore the relationship between severity of WML and cognitive function.The t/Z test was used to explore the relationship between cognitive function and TCD hemodynamic indexes in WML patients.Results:1.There were significant differences between CI and CN group in terms of age,sex,drinking history,hypertension,hyperhomocysteinemia(P<0.05).Among them,age and hypertension may be independent risk factors for cognitive dysfunction in WML patients,with OR values of 1.050(1.009-1.093)and 2.322(1.069-5.044),respectively.Homocysteine(Hcy)in CI group was higher and the fasting blood glucose(FBG)was lower(P<0.05).Age and Hcy were negatively correlated with MMSE and MOCA scores.2.There were statistically significant differences in the total scores of MMSE and Mo CA,visuospatial and executive function,naming ability,attention,language ability,abstraction ability,delayed recall and orientation ability among the 3 groups A,B and C(P<0.05).MMSE,Mo CA and the scores of each cognitive domain were negatively correlated with Fazekas scores(P<0.05).3.ACAPI and MCAPI of the CI group were higher than those of CN group(P<0.05).The scores of MMSE,MOCA,attention and delayed recall were all negatively correlated with ACAPI and MCAPI,and orientation ability was negatively correlated with ACAPI.Conclusions:1.The age,gender and drinking history of WML patients may related to the occurrence of cognitive dysfunction.The risk factors for cognitive impairment in WML patients may be age and hypertension.FBG and Hcy may related to cognitive impairment in WML patients.The control of these risk factors may help to delay the onset of cognitive impairment in WML patients.2.The more severe the degree of WML in patients is,the more severe the decline of cognitive function is.3.The ACAPI and MCAPI of WML patients with cognitive impairment may higher than those without cognitive impairment,and the higher the value is,the more severe the degree of cognitive impairment is.