Li Xuanting, Yang Shuna, Li Yue, Qin Wei, Yang Lei, Yuan Junliang, Hu Wenli
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Neurology, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China.
Front Aging Neurosci. 2023 Apr 11;15:1114426. doi: 10.3389/fnagi.2023.1114426. eCollection 2023.
The clinical features and pathological process of cerebral microbleed (CMB)-related cognitive impairment are hot topics of cerebral small vessel disease (CSVD). However, how to choose a more suitable cognitive assessment battery for CMB patients is still an urgent issue to be solved. This study aimed to analyze the performance of CMB patients on different cognitive tests.
This study was designed as a cross-sectional study. The five main markers of CSVD (including the CMB, white matter hyperintensities, perivascular spaces, lacunes and brain atrophy) were assessed according to magnetic resonance imaging. The burden of CMB was categorized into four grades based on the total number of lesions. Cognitive function was assessed by Mini-Mental State Examination (MMSE), Trail-Making Test (TMT, Part A and Part B), Stroop color-word test (Stroop test, Part A, B and C), Verbal Fluency Test (VF, animal), Digit-Symbol Substitution Test (DSST), Digit Cancellation Test (DCT) and Maze. Multiple linear regression analysis was conducted to analyze the association between CMB and cognitive findings.
A total of 563 participants (median age of 69 years) were enrolled in this study, including 218 (38.7%) CMB patients. CMB patients showed worse performance than non-CMB subjects in each cognitive test. Correlation analysis indicated the total number of CMB lesions had positive correlations with the time of TMT, Maze and Stroop test, and negative correlations with the performance of MMSE, VF, DSST, and DCT. After the adjustment for all the potential confounders by linear regression, the CMB burden grade was correlated with the performance of VF, Stroop test C, Maze and DCT.
The presence of CMB lesions was associated with much worse cognitive performances. In VF, Stroop test C, Maze and DCT, the correlations between CMB severity and assessment results were more significant. Our study further confirmed that the attention/executive function domain was the most commonly evaluated in CMB, which provided a picture of the most utilized tools to analyze the prognostic and diagnostic value in CMB.
脑微出血（CMB）相关认知障碍的临床特征和病理过程是脑小血管病（CSVD）的研究热点。然而，如何为CMB患者选择更合适的认知评估组合仍是亟待解决的问题。本研究旨在分析CMB患者在不同认知测试中的表现。
本研究设计为横断面研究。根据磁共振成像评估CSVD的五个主要标志物（包括CMB、白质高信号、血管周围间隙、腔隙和脑萎缩）。CMB负荷根据病变总数分为四个等级。认知功能通过简易精神状态检查表（MMSE）、连线测验（TMT，A部分和B部分）、斯特鲁普色词测验（斯特鲁普测验，A、B和C部分）、语言流畅性测验（VF，动物）、数字符号替换测验（DSST）、数字划消测验（DCT）和迷宫测试进行评估。进行多元线性回归分析以分析CMB与认知结果之间的关联。
本研究共纳入563名参与者（中位年龄69岁），其中218名（38.7%）为CMB患者。在每项认知测试中，CMB患者的表现均比非CMB受试者差。相关性分析表明，CMB病变总数与TMT、迷宫测试和斯特鲁普测验的用时呈正相关，与MMSE、VF、DSST和DCT的表现呈负相关。通过线性回归对所有潜在混杂因素进行校正后，CMB负荷等级与VF、斯特鲁普测验C部分、迷宫测试和DCT的表现相关。
CMB病变的存在与更差的认知表现相关。在VF、斯特鲁普测验C部分、迷宫测试和DCT中，CMB严重程度与评估结果之间的相关性更为显著。我们的研究进一步证实，注意力/执行功能领域是CMB中最常评估的领域，这为分析CMB预后和诊断价值的最常用工具提供了依据。
