Risk Factors Of Cerebral Microbleeds In Patients With Acute Mild Ischemic Stroke And Its Relevance To Cognitive Function

Objective:Previous studies have found that the pathogenesis of cerebral microbleeds(CMBs)is related to vascular risk factors and vascular wall damage caused by β-amyloid accumulation,which is closely related to cognitive decline.At present,there is no consensus on the risk factors and related pathogenesis of CMBs in patients with acute mild ischemic stroke.The purpose of this study was to determine the clinical risk factors related to the load and distribution of CMBs in patients with acute mild ischemic stroke and their impact on cognitive function.Methods:In this study,patients with acute mild ischemic stroke in our hospital were enrolled consecutively from November 2021 to October 2022.The number of CMBs was divided into three groups: non-CMBs(N=0),mild CMBs(N=1-4),and severe CMBs(N≥5).According to distribution,CMBs were divided into four groups: non-CMBs,lobar CMBs,deep CMBs and mixed CMBs.Single factor analysis of variance,Kruskal-Wallis H test and logistic regression analysis were used to analyze the risk factors related to CMBs;Multiple linear regression was used to analyze the correlation between the number and distribution of cerebral microbleeds and the overall cognitive function and various cognitive domains.Results:1.325 patients with acute mild ischemic stroke were enrolled in this study,with an average age of 63.4(± 11.3)years,and 232 males(71.4%).The detection rate of cerebral microbleeds was 41.5%(135/325),of which28.3%(92/325)were patients with mild CMBs and 13.2%(92/325)were patients with severe CMBs.Patients with lobar CMBs accounted for 5.5%(18/325),patients with deep CMBs accounted for 21.2%(69/325),and patients with mixed CMBs accounted for 14.8%(48/325).2.Risk factors of cerebral microbleeds load and distribution: The results of one-way ANOVA and Kruskal Wallis H test showed that older age,diabetes,stroke history,hyperlipidemia,white matter lesions and lacunae were associated with the increase of cerebral microbleeds load,and were independently associated with white matter lesions and lacunae.Compared with non-CMBs,the distribution of CMBs has statistical differences with older age,history of stroke,high triglyceride,white matter lesions and more lacunae.The results of multivariate disordered logistic analysis showed that compared with non-CMBs,deep and lobar CMBs were independently associated with paraventricular white matter high signal(OR=2.3,95%CI1.3-3.9,P=0.002)and lacunar(OR=1.4,95%CI 1.1-1.7,P=0.003),and paraventricular white matter high signal(OR=2.8,95%CI 1.5-5.3,P=0.002)and lacunar(OR=1.9,95%CI 1.6-2.3,P<0.001)and the presence of mixed CMBs,However,the presence of lobar CMBs was only correlated with lacuna(OR 1.7,95%CI 1.3-2.3,P<0.001).3.The relationship between the load and distribution of cerebral microbleeds and cognitive function: linear regression analysis showed that the existence of cerebral microbleeds was negatively correlated with the decline of MMSE(β=-1.3,95CI%=-2.4,-0.2,P=0.022)and Mo CA(β=-1.8,95CI%=-3.3,-0.3,P=0.018).Compared with no intracerebral microbleeds,mild CMBs had no correlation with the overall cognitive function,but when CMBs≥5,it was linearly related to the decline of the overall cognitive function,and was related to the reduction of visual/executive function,attention,language,abstract ability,and delayed memory score.In the distribution grouping of cerebral microbleeds,it was found that both lobar microbleeds and deep CMBs had no linear correlation with the decline of overall cognitive function and various cognitive fields.Mixed CMBs are related to attention,language and abstract ability,and negatively related to executive function,naming,delayed memory and orientation.Conclusions:In the acute mild ischemic stroke population,the detection rate of cerebral microbleeds is high,and age,diabetes,stroke history,blood lipid levels and other small cerebral vascular markers are related to the increase in the number of cerebral microbleeds.The existence and distribution of cerebral microbleeds related to cognitive dysfunction and have cumulative effects.