Department of Neurology, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), 519099 Zhuhai, Guangdong, China.
J Integr Neurosci. 2024 Sep 30;23(10):187. doi: 10.31083/j.jin2310187.
Enlarged perivascular spaces (EPVSs) are commonly detected via magnetic resonance imaging. It is unclear whether EPVSs are associated with cognitive impairment within one month after an acute ischemic stroke (AIS) (i.e., early AIS with cognitive impairment (EAIS-CI)). This study explored the severity and location of EPVSs and their association with EAIS-CI severity and provides clinicians with early warning indicators before the onset of typical clinical symptoms in the Chinese population.
The clinical data of 208 patients (176 AIS patients and 32 controls) were prospectively analyzed using the Montreal Cognitive Assessment Beijing version (MoCA-BJ) score as the primary group criterion and the Mini-Mental State Examination (MMSE) score as a supplementary criterion. When EPVS I as the main EPVS type detected by imaging, the basal ganglia (BG) is the area most severely affected. Statistical analysis was conducted on the relevant clinical data.
AIS patients were grouped based on MoCA-BJ scores. Age ( < 0.01), education level ( = 0.02), EPVS I as the main EPVS type ( < 0.01), the number of right-sided BG-EPVSs ( = 0.04), white matter hyperintensities (WMHs) (Fazekas scores: = 0.02), brain atrophy (global cortical atrophy scores: < 0.01, Koedam posterior atrophy visual scale scores: = 0.01, medial temporal lobe atrophy scores: < 0.01) and AIS lesion volume ( = 0.01) were significantly greater in the EAIS-CI group than in the EAIS without cognitive impairment group. The cognitive domains of attention ( = 0.04) and orientation ( < 0.01) were more closely associated with EPVS I as the main EPVS type. However, multivariate regression analysis did not identify EPVS I as the main EPVS type as the main risk factor for EAIS-CI ( = 0.098). Grouping by MMSE scores revealed that EPVS I as the main EPVS type was linked to low education level ( < 0.01) and was significantly associated with EAIS in individuals with cognitive dementia ( < 0.01).
As a result of multiple factors, EAIS-CI is significantly associated with a low education level, BG-EPVS, WMHs, and worsening brain atrophy severity. Imaging markers, such as the severity of BG-EPVS, can assist in the early diagnosis and assessment of EAIS-CI.
The study was registered with the China Clinical Trial Registry (https://www.chictr.org.cn/), registration number: ChiCTR2000038819.
血管周围空间扩大（EPVS）在磁共振成像中通常被检测到。目前尚不清楚 EPVS 是否与急性缺血性脑卒中（AIS）后一个月内的认知障碍（即早期 AIS 伴认知障碍（EAIS-CI））有关。本研究探讨了 EPVS 的严重程度和位置及其与 EAIS-CI 严重程度的关系，并为中国人群中典型临床症状出现前提供了临床预警指标。
前瞻性分析了 208 例患者（176 例 AIS 患者和 32 例对照）的临床数据，采用蒙特利尔认知评估北京版（MoCA-BJ）评分作为主要组标准，采用简易精神状态检查（MMSE）评分作为补充标准。当以 EPVS I 作为主要 EPVS 类型进行成像时，基底节（BG）是受影响最严重的区域。对相关临床数据进行统计学分析。
根据 MoCA-BJ 评分对 AIS 患者进行分组。年龄（<0.01）、教育程度（=0.02）、以 EPVS I 为主的 EPVS 类型（<0.01）、右侧 BG-EPVS 数量（=0.04）、脑白质高信号（Fazekas 评分：=0.02）、脑萎缩（全皮质萎缩评分：<0.01，Koedam 后萎缩视觉评分：=0.01，海马体萎缩评分：<0.01）和 AIS 病变体积（=0.01）在 EAIS-CI 组中明显大于 EAIS 无认知障碍组。注意力（=0.04）和定向（<0.01）认知域与以 EPVS I 为主的 EPVS 类型更密切相关。然而，多变量回归分析并未将 EPVS I 作为主要 EPVS 类型确定为 EAIS-CI 的主要危险因素（=0.098）。根据 MMSE 评分进行分组显示，以 EPVS I 为主的 EPVS 类型与受教育程度较低（<0.01）有关，并且与认知障碍的 EAIS 患者（<0.01）显著相关。
由于多种因素的影响，EAIS-CI 与受教育程度低、BG-EPVS、WMHs 和脑萎缩严重程度恶化显著相关。影像学标志物，如 BG-EPVS 的严重程度，有助于 EAIS-CI 的早期诊断和评估。
该研究在中国临床试验注册中心（https://www.chictr.org.cn/）进行了注册，注册号：ChiCTR2000038819。
