Hua Min, Ma Ai-Jin, Liu Zhi-Qing, Ji Li-Li, Zhang Jin, Xu Yuan-Feng, Chen Wen-Ya, Mao Lun-Lin
Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China.
Front Aging Neurosci. 2023 Jul 14;15:1163349. doi: 10.3389/fnagi.2023.1163349. eCollection 2023.
Arteriolosclerosis cerebral small vessel disease (CSVD) is a common type of CSVD. This study aimed to explore the factors associated with cognitive function and total MRI burden related to the disease.
The demographic characteristics, clinical manifestations, cognitive function score, Barthel Index (BI), blood test index, and follow-up results of arteriolosclerosis CSVD patients treated for the first time in our hospital from January 2014 to August 2022 were collected. White matter hyperintensity (WMH) Fazekas score, total MRI burden, and cerebral atrophy grade were evaluated according to brain MRI findings. Factors associated with CSVD cognitive function were analyzed by binary logistic regression. The correlative factors related to the total MRI burden of CSVD were analyzed by ordered multiple logistic regression.
A total of 146 patients were included in this study, of which 132 cases (90.4%) had hypertension. There were 108 patients (74.0%) with cognitive dysfunction, 97 patients (66.4%) with balance and gait disorders, and 83 patients (56.8%) with moderate-to-severe dependence in daily life (BI ≤ 60 points). Of 146 patients, 79 (54.1%) completed clinical and imaging follow-ups for a median of 3 years. The number of patients with cognitive impairment and BI ≤ 60 points after follow-up significantly increased compared with the first admission ( < 0.001). There were also significant differences in total MRI burden ( = 0.001), WMH Fazekas score, and cerebral atrophy grade ( < 0.001). Mean age ( = 0.012), median deep WMH Fazekas score ( = 0.028), and median deep ( < 0.001) and superficial ( =0.002) cerebral atrophy grade of patients with cognitive impairment at first admission were all higher than those with non-cognitive impairment. Multivariate analysis showed that deep cerebral atrophy was independently and significantly associated with cognitive impairment of CSVD ( = 0.024), and hypertension was significantly and independently associated with total MRI burden ( = 0.001).
The disease course of arteriolosclerosis CSVD may be related to cognitive function and total MRI burden. Deep cerebral atrophy was an independent risk factor for cognitive dysfunction in arteriolosclerosis CSVD, and hypertension was an independent risk factor for total MRI burden.
脑小血管病中的动脉硬化型是常见类型。本研究旨在探讨与该疾病相关的认知功能及MRI总负荷的影响因素。
收集2014年1月至2022年8月在我院首次接受治疗的动脉硬化型脑小血管病患者的人口学特征、临床表现、认知功能评分、Barthel指数（BI）、血液检查指标及随访结果。根据脑部MRI表现评估白质高信号（WMH）Fazekas评分、MRI总负荷及脑萎缩程度。采用二元逻辑回归分析与脑小血管病认知功能相关的因素。采用有序多分类逻辑回归分析与脑小血管病MRI总负荷相关的因素。
本研究共纳入146例患者，其中132例（90.4%）患有高血压。有108例（74.0%）患者存在认知功能障碍，97例（66.4%）患者存在平衡和步态障碍，83例（56.8%）患者在日常生活中存在中度至重度依赖（BI≤60分）。146例患者中，79例（54.1%）完成了临床和影像学随访，中位随访时间为3年。随访后认知障碍和BI≤60分的患者数量较首次入院时显著增加（<0.001）。MRI总负荷（=0.001）、WMH Fazekas评分及脑萎缩程度（<0.001）也存在显著差异。首次入院时存在认知障碍的患者的平均年龄（=0.012）、深部WMH Fazekas评分中位数（=0.028）以及深部（<0.001）和浅部（=0.002）脑萎缩程度中位数均高于无认知障碍的患者。多因素分析显示，深部脑萎缩与脑小血管病的认知障碍独立且显著相关（=0.024），高血压与MRI总负荷显著且独立相关（=0.001）。
动脉硬化型脑小血管病的病程可能与认知功能及MRI总负荷有关。深部脑萎缩是动脉硬化型脑小血管病认知功能障碍的独立危险因素，高血压是MRI总负荷的独立危险因素。
