Study On The Relationship Between Cognitive Impairment Of Cerebral Small Vessel Disease And Phlegm-dampness Constitution Based On Total MRI Burden

Objective:To study the effect of different degrees of total MRI burden on the overall cognitive function and each cognitive domain,to explore the correlation between the severity of total MRI burden and phlegm-dampness constitution,and to screen the related risk factors.Methods:Patients with one or several combinations of cerebral small vessel disease(CSVD)and lacunes(LAC),white matter hyperintensities(WMH),perivascular space(PVS)and cerebral microbleed(CMB)shown by imaging data who visited our hospital from January 2021 to February 2022were included in the study,and the clinical data and biochemical test results of the patients were collected.According to the scoring method of total MRI burden of CSVD,the enrolled patients were generally assessed for imaging characteristics,which were divided into mild group(0 point),moderate group(1～2 points)and severe group(3～4 points),and the lesion characteristics were separately graded for severity.According to the TCM constitution determination table,the patients were divided into peaceful quality group,phlegm-dampness quality group and other biased constitution groups.Mini-mental State Examination(MMSE)and Montreal Cognitive Assessment(Mo CA)were used to assess overall cognitive function,Trail Making Test Part A(TMT-A)was used to assess attention and processing speed,Trail Making Test Part B(TMT-B)was used to assess executive function,Boston Naming Test-30(BNT-30)was used to assess language function,Hopkins Verbal Learning Test-Revised(HVLT-R)was used to assess learning and memory ability,and Clock Drawing Test(CDT)was used to assess visuospatial ability.Relevant data were collated and statistically analyzed to study the effect of different degrees of total MRI burden on cognitive impairment in CSVD and the correlation between total MRI burden and phlegm-dampness constitution.Results:1.Compared with the mild to moderate group,the patients in the severe group had older age,higher constituent ratio of hypertension,diabetes,smoking and phlegm-dampness,and the differences were statistically significant(P<0.05).2.Multiple ordinal logistic regression analysis showed that sputum dampness(OR:3.056,95%CI:1.114～8.384),age(OR:1.067,95%CI:1.005～1.132)and diabetes(OR:3.437,95%CI:1.150～10.267)were independent risk factors for increased total MRI burden of CSVD.3.For CSVD patients:phlegm-dampness compared with peaceful quality and other biased constitution,body mass index(BMI)level was high,and hyperlipidemia,smoking history,alcohol abuse history,and non-peaceful emotional composition ratio were high,and the differences were statistically significant(P<0.05).Binary logistic regression analysis revealed that only high BMI(OR:1.274,95%CI:1.039 to 1.561)level was an independent risk factor for phlegm-dampness.4.Spearman correlation analysis showed that the severity of total MRI burden was negatively correlated with MMSE total score(r_s=-0.662,P=0.000),Mo CA total score(r_s=-0.724,P=0.000),number of spontaneous naming correct(r_s=-0.269,P=0.019),percentage of BNT-30 prompt naming correct(r_s=-0.246,P=0.032),percentage of BNT-30 choice naming correct(r_s=-0.350,P=0.002),and HVLT-R instantaneous memory score(r_s=-0.297,P=0.009),and positively correlated with TMT-A time consumption(r_s=-0.730,P=0.000)and TMT-B time consumption(r_s=-0.719,P=0.000).5.The results of linear regression analysis showed that the time of attention and processing speed(B:13.618,P:0.010)and executive function(B:19.965,P:0.022)increased significantly in moderate and mild total MRI burden.When severe and mild were compared,MMSE total score(B:-7.778,P:0.000),Mo CA total score(B:-10.072,P:0.000),number of correct spontaneous naming(B:-2.296,P:0.022),percentage of correct choice naming(B:-0.168,P:0.010),and instantaneous recall score(B:-3.508,P:0.010)decreased significantly,and attention and processing speed(B:45.542,P:0.000)and executive function(B:85.995,P:0.000)took significantly more time.6.There were significant differences in the severity of LAC,paraventricular white matter hyperintensity(PVH),enlarged perivascular space in basal ganglia(BG-EPVS),and CMB among the three groups of phlegm-dampness,calmness,and other biased constitution(P<0.05).7.Pairwise comparison of H test revealed that phlegm-dampness accounted for more severe parts in LAC,PVH and CMB than peaceful quality,and the difference was statistically significant(P<0.05),and other biased constitution accounted for more severe parts in BG-EVPS than peaceful quality and phlegm-dampness,and the difference was statistically significant(P<0.05).Conclusion:1.Older age,hypertension,diabetes,smoking history,and sputum dampness may be risk factors for the total MRI burden of CSVD.Older age,diabetes,and sputum wetness were independent risk factors for increased total MRI burden.2.For CSVD patients:high BMI level,smoking,alcohol abuse,and emotional distress may be the occurrence factors of phlegm-dampness constitution,and phlegm-dampness further promotes the occurrence of hyperlipidemia.High BMI level is an independent risk factor for the development of sputum dampness.3.The severity of total MRI load is correlated with the negative degree of cognitive function.With the increase of total load,the time of attention and processing speed,executive function first increases,followed by the decline of overall cognitive function,language,instantaneous memory ability decline.Mild to moderate CSVD may only affect attention and processing speed,executive ability,while severe total load is the cut-off point for the appearance of extensive cognitive impairment.4.Phlegm-dampness may predispose to increased severity of LAC,PVH,and CMB,while other biased constitutions predispose to increased severity of BG-EPVS.