Recognition Characteristics And Related Factors Of Cognitive Impairment Of Cerebral Small Vessel Disease

Objective: Coming into the aging society,the incidence rate of cognitive dysfunction has gradually increased.Vascular cognitive impairment is one of the main reason.The proportion of cerebral vascular disease is the highest.The onset of small cerebral vascular disease(CSVD)is insidious,slow progress,and gradually appeared cognitive impairment.The clinical characteristics of cognitive impairment of CSVD is helpful to early identification,the prevention and treatment of cognitive impairment.Materials and methods:Part one: 270 CSVD patients with independent living ability were selected from the Department of Neurology of the Affiliated Hospital of Tianjin Institute of traditional Chinese medicine from December 2018 to December 2021.The clinical data of patients were collected.Compared with the normal healthy group,the cognitive characteristics of csvd patients were summarized;ROC curve was used to analyze the predictive value of different neuropsychological scales on cognitive impairment of cerebrovascular disease;According to neuropsychological evaluation,they were divided into normal cognition group,mild cognitive impairment group and vascular dementia group.The characteristics of the three groups were compared.Part two: The clinical data of the patients were analyzed retrospectively,and the laboratory tests of the hospital in recent one week were recorded.including fasting blood glucose(FBG),glycosylated hemoglobin,blood creatinine,and so on.According to neuropsychological evaluation,the patients were divided into cognitive normal group,mild cognitive impairment group and dementia group.The main influencing factors of csvd cognitive impairment were analyzed by multivariate logistic regression.Part three: The fasting venous blood samples of 60 patients in the whole sample were randomly selected.The serum inflammatory factors were detected by ELISA,and the relationship between the level of relevant inflammatory factors and the cognitive function of small vascular disease was compared.Results:Part one: A total of 270 patients with CSVD were included in the study,including173 males(64.07%)and 97 females(35.93%),with an average age of 41-90 years(65.02 ± 7.88).Their education level was mainly in junior middle school and senior high school.Compared with the healthy control group,there was no significant difference in gender,age and education years between the two groups.21.12±3.20 vs24.7±3.03.In each cognitive field,the impairment of visuospatial ability and delayed recall ability was the main,and the difference was statistically significant(P < 0.05).There was significant different with the impairment of visuospatial ability and delayed recall ability(P < 0.05).According to the ROC curve analysis,MMSE,MOCA and tug single have good predictive value for cerebral small vessel cognitive impairment.According to the cognitive level and years of education,the prediction value of MMSE was the best,AUC was 0.871,the best prediction threshold was 27.5,sensitivity was 70.7%,specificity was 94.7,followed by MOCA and tug single completion time;For those with mild cognitive impairment after high education,MOCA had the best predictive value,AUC 0.790,and the best predictive critical values were 24.5,sensitivity 81.4%,specificity 74.1%,followed by MMSE and tug single completion time;Part two: The patients with hypertension were the most,230(85.19%),with symptomatic cerebral infarction were 216 patients(80%)and chronic kidney disease were 27.78%.There was significant difference between the two groups(P < 0.05).There was significant different with the impairment of visuospatial ability and delayed recall ability(P < 0.05).The completion time of connection test a and connection test B was significantly longer than that of the normal group(P = 0.027,P= 0.007).The average completion time of TUG-single test was 19.62 ± 9.19 seconds,which were longer than those in the normal group(P < 0.05).The patients were divided into two groups: normal cognition group and cognitive impairment group.The average age of the two groups was(65.30 ± 6.84)vs(61.74 ± 9.82),the difference was statistically significant(P = 0.019);The ratio of previous symptomatic cerebral infarction history,fasting blood glucose level,blood creatinine level,urea nitrogen level,blood fibrinogen level and nuclear magnetic resonance small vessel disease load were statistically significant(P = 0.005,P = 0.049,P < 0.001,P < 0.001,P = 0.009,P = 0.001).Logistic regression analysis showed that age,fasting blood glucose level and the number of lacunar cerebral infarction were the main influencing factors of cerebrovascular cognitive impairment.The decrease of night sleep efficiency was related to CSVD cognitive impairment(P = 0.020).The decrease of daytime function affected the cognitive level of CSVD(P = 0.043).The length of education was significantly correlated with the level of csvd cognitive impairment.Part three:A total of 60 patients with csvd were included,including 33 males(55%)and 27 females(45%),with an average age of 64.31 ± 8.32 years,a history of drinking about 31.67% and a history of smoking about 48.3%.The mean MOCA score was 22.23 ± 5.10 and the mean MMSE score was 26.54 ± 3.86.Compared with the normal control group,the levels of MMP-9,Cy PA,VEGF and E-selection in patients with CSVD cognitive impairment increased and levels of TGF-β1 decreased,and the difference was statistically significant.Conclusion: The overall cognitive ability of patients with CSVD is decreased,which is mainly manifested in the impairment of executive ability and information processing speed represented by connection test A-B,visuospatial ability represented by drawing,and delayed recall ability represented by recalling words.Fasting blood glucose level,symptomatic cerebral infarction history and the number of lacunar cerebral infarction are the main risk factors of cognitive impairment.MOCA has the best predictive value for MCI.Gait assessment can be used as an assessment method of CSVD cognitive impairment and provide more objective indicators.Age,years of education,image load of small cerebrovascular disease and blood fibrinogen level were related to the degree of cognitive decline in patients with CSVD.Sleep disorders,especially the decline of daytime function,are related to cerebrovascular cognitive impairment.Chronic inflammatory reaction,endothelial cell injury and cell matrix destruction may be involved in the occurrence of csvd cognitive impairment.