Zhang Weiyi, Fu Weilun, Zhang Yumei
Department of Rehabilitation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China.
J Alzheimers Dis Rep. 2024 Jun 21;8(1):999-1007. doi: 10.3233/ADR-240007. eCollection 2024.
Effect of stenosis of vertebrobasilar artery (VBA) on cognitive function is elusive.
To investigate association of cerebral hypoperfusion and poor collaterals with vascular cognitive impairment (VCI) in severe VBA stenosis patients.
We consecutively enrolled patients with severe VBA stenosis confirmed by digital subtraction angiography who underwent computed tomographic perfusion (CTP) and cognitive assessments. Patients were divided into poor or good collaterals groups according to the collateral circulation status, and were grouped into different perfusion groups according to CTP. Cognitive function was measured by Montreal Cognitive Assessment (MoCA), Clock Drawing Test, Stroop Color Word Test, Trail Making Test, Digital Span Test, Auditory Verbal Learning Test, and Boston Naming Test scales. The association of cerebral perfusion and collaterals with VCI were explored.
Among 88 eligible patients, VCI occurred in 51 (57.9%) patients experienced. Poor collateral was present in 73 (83.0%) patients, and hypoperfusion in 64 (72.7%). Compared with normal perfusion patients, the odds ratio with 95% confidence interval for VCI was 12.5 (3.7-42.4) for overall hypoperfusion, 31.0 (7.1-135.5) for multiple site hypoperfusion, 3.3 (1.0-10.5) for poor collaterals, and 0.1 (0-0.6) for presence of posterior communicating artery (PcoA) compensated for posterior cerebral artery (PCA) and basilar artery (BA). Additionally, decreased scores of cognitive function tests occurred in patients with decompensated perfusion or poor collaterals.
Hypoperfusion and poor collaterals were positively associated with cognitive impairment in patients with severe VBA. However, PcoA compensated for the PCA and BA had a protective role in cognitive impairment development.
椎基底动脉（VBA）狭窄对认知功能的影响尚不明确。
探讨严重VBA狭窄患者脑灌注不足和侧支循环不良与血管性认知障碍（VCI）的关系。
我们连续纳入经数字减影血管造影证实为严重VBA狭窄且接受了计算机断层扫描灌注（CTP）和认知评估的患者。根据侧支循环状态将患者分为侧支循环不良或良好组，并根据CTP将其分为不同的灌注组。采用蒙特利尔认知评估量表（MoCA）、画钟试验、斯特鲁普色词测验、连线测验、数字广度测验、听觉词语学习测验和波士顿命名测验量表测量认知功能。探讨脑灌注和侧支循环与VCI的关系。
在88例符合条件的患者中，51例（57.9%）出现VCI。73例（83.0%）患者存在侧支循环不良，64例（72.7%）存在灌注不足。与正常灌注患者相比，总体灌注不足时VCI的95%置信区间的比值比为12.5（3.7-42.4），多部位灌注不足时为31.0（7.1-135.5），侧支循环不良时为3.3（1.0-10.5），后交通动脉（PcoA）代偿大脑后动脉（PCA）和基底动脉（BA）时为0.1（0-0.6）。此外，灌注失代偿或侧支循环不良的患者认知功能测试得分降低。
严重VBA患者灌注不足和侧支循环不良与认知障碍呈正相关。然而，PcoA代偿PCA和BA对认知障碍的发生具有保护作用。
