Correlation Between The Total MRI Burden Of Cerebral Small Vessel Disease And Cognitive Impairment In Patients With Atrial Fibrillation Related Stroke

Objective:To probe the relationship between the total MRI burden of cerebral small vessel disease（CSVD）and cognitive impairment in patients with atrial fibrillation related stroke.Methods:Application prospective cohort study.Included patients with acute cerebral infarction who were hospitalized in the Department of Neurology,Qingdao University Affiliated Hospital from September 2018 to January 2021.On the basis of TOAST etiology classification,181 patients with cardiogenic embolism related to the etiology of atrial fibrillation were screened out.Collect patients’demographic information and routine laboratory tests.According to the"total CSVD score"of MRI,the patients were divided into 4 groups:0,1,2,3-4.Mo CA was used to assess the cognitive function of the enrolled patients within 48 hours of admission（baseline）,14 days after stroke,and 90 days after stroke.According to the score of 90 days after stroke,they were divided into cognitive impairment group and non cognitive impairment group.Apply statistical analysis to explore the relationship between the total MRI burden of CSVD and cognitive impairment in patients with atrial fibrillation related stroke and the correlation between the scores of various cognitive domains.Results:A total of 168 patients completed the follow-up with complete data,the results are as follows:（1）The incidence of cognitive impairment was different at different periods after the onset of atrial fibrillation related stroke.Within 48 hours of admission（baseline）,14 days after stroke,and 90 days after stroke,the incidence of cognitive impairment was 66.85%,65.17%and 63.10%respectively.（2）The clinical data of 4 groups of patients with different total CSVD scores were analyzed.The results showed that different total CSVD scores were related to age,hypertension,smoking,MOCA score and CHA2DS2-VASc score,and there were statistical differences（P<0.05）.（3）Based on the clinical data of the four groups,it was found that age and CHA2DS2-VASc score were positively correlated with the total CSVD score after conducting Spearman rank correlation analysis(>0,P<0.05).Baseline MOCA score,MOCA score14 days after stroke,and MOCA score 90 days after stroke were negatively correlated with the total CSVD score(<0,P<0.05).（4）Statistical analysis of the two groups with or without cognitive impairment showed that cognitive impairment was related to age,smoking,drinking,the total CSVD score,CHA2DS2-VASc score,frontal lobe and thalamic infarction,and the results were statistically differences（P<0.05）.Application of multi-factor logistic regression analysis showed that age,CHA2DS2-VASc score,the total CSVD score,and frontal lobe infarction were independent risk factors for cognitive impairment 90 days after atrial fibrillation related stroke.Comparison of cognitive function sub-items,results showed that the cognitive impairments of patients with atrial fibrillation related stroke with different total CSVD score were mainly visual space and executive ability,language and delayed recall ability.Conclusion:（1）The total MRI burden of CSVD can be used as early indicators in imaging to predict the occurrence of cognitive impairment in patients with atrial fibrillation related stroke.（2）Age,hypertension,smoking and CHA2DS2-VASc score may be significant risk factors for the total MRI burden of CSVD in patients with atrial fibrillation related stroke.（3）Age,smoking,drinking,location of infarction,CHA2DS2-VASc score and the total CSVD score are significant risk factors for cognitive impairment in patients with atrial fibrillation related stroke.（4）The cognitive domain impairment of patients with atrial fibrillation related stroke is mainly visual space and executive ability,language and delayed recall ability.