Zhang Nan, Xie Binbin, Feng Yuxue, Li Qin, Li Xiaofeng
Department of Neurology, The second affiliated hospital of Chongqing Medical University, Chongqing, China.
Department of Neurology, The second affiliated hospital of Chongqing Medical University, Chongqing, China.
Clin Neurol Neurosurg. 2023 Oct;233:107889. doi: 10.1016/j.clineuro.2023.107889. Epub 2023 Jul 11.
The purpose of this study is to investigate how cognition is affected by asymptomatic cerebral artery stenosis (CAS) of the anterior circulation and its related collateral circulation.
102 patients with CAS of the anterior circulation and 52 controls were enrolled from January 1, 2019 to June 30, 2022. Patients with CAS of anterior circulation were further divided into different subgroups according to the degree of stenosis, cerebral perfusion, and collateral circulation. A series of neuropsychological scales were used to evaluate the participant's cognitive function, activities of daily living, and neuropsychiatric symptoms (such as memory, execution, psychomotor speed, etc.). The data were analyzed using T-test, F-test, chi-square test, rank sum test, and other statistical methods, moreover, the quantitative data were further examined for trends. The relationship between the degree of CAS, cerebral perfusion, collateral circulation, and the outcome of the cognitive test was investigated using Spearman correlation analysis.
Compared to controls, there were severe impairments of global cognition, psychomotor speed/execution, memory, attention, activities of daily living, and more neuropsychiatric symptoms in patients with anterior circulation CAS (p < 0.05), and these impairments got worsened with the aggravation of CAS (p < 0.05). The global cognition, psychomotor speed / executive function, memory function, and daily living ability were impaired both in the cerebral perfusion-compensated group and decompensated group(p < 0.05), while there was no statistically significant difference between the two groups (p > 0.05). With the aggravation of CAS, the proportion of poor collateral formation increased, and this difference was statistically significant (P < 0.01). The degree of stenosis, cerebral perfusion, and collateral circulation establishment of anterior circulation CAS was correlated with global cognition, memory, psychomotor speed, execution, attention, activities of daily living, and neuropsychiatric symptoms (all p < 0.01).
Cognitive impairment and the percentage of inadequate collateral circulation development rise as stenosis progresses in patients with anterior circulation CAS. The decline in global cognitive function was accompanied by impairments in psychomotor speed / executive function, memory function, attention, and daily living skills, as well as the aggravation of neuropsychiatric symptoms, especially in patients with impaired cerebral perfusion and poor collateral circulation formation.
本研究旨在探讨前循环无症状性脑动脉狭窄（CAS）及其相关侧支循环如何影响认知。
2019年1月1日至2022年6月30日纳入102例前循环CAS患者和52例对照。前循环CAS患者根据狭窄程度、脑灌注和侧支循环进一步分为不同亚组。使用一系列神经心理学量表评估参与者的认知功能、日常生活活动和神经精神症状（如记忆、执行、精神运动速度等）。采用t检验、F检验、卡方检验、秩和检验等统计方法对数据进行分析，此外，对定量数据进一步检验趋势。采用Spearman相关分析研究CAS程度、脑灌注、侧支循环与认知测试结果之间的关系。
与对照组相比，前循环CAS患者在整体认知、精神运动速度/执行、记忆、注意力、日常生活活动方面存在严重损害，且神经精神症状更多（p<0.05），这些损害随着CAS的加重而恶化（p<0.05）。脑灌注代偿组和失代偿组的整体认知、精神运动速度/执行功能、记忆功能和日常生活能力均受损（p<0.05），但两组之间无统计学显著差异（p>0.05）。随着CAS的加重，侧支形成不良的比例增加，且差异具有统计学意义（P<0.01）。前循环CAS的狭窄程度、脑灌注和侧支循环建立与整体认知、记忆、精神运动速度、执行、注意力、日常生活活动和神经精神症状相关（均p<0.01）。
前循环CAS患者的认知障碍和侧支循环发育不足的百分比随着狭窄进展而上升。整体认知功能下降伴随着精神运动速度/执行功能、记忆功能、注意力和日常生活技能的损害，以及神经精神症状的加重，尤其是在脑灌注受损和侧支循环形成不良的患者中。
