The Cognitive Changes In Patients With Lacunar Infarction And Carotid Stenosis After Antery-intervention Therapy

Objective To observe the characteristics of the cognitive changes in patients with lacunar infarction(LI) and to explore the influence of the cognitive function and related dangerous factors in patients with LI after carotid artery stenting(CAS).Methods①Neuropsychological tests (Montreal Cognitive Assessment, Mini-Mental State Exam ination) were conducted in43patients with LI before CAS and1month,6months,12months after CAS and the scores were compared with those of41healthy cases.②The further evaluation was implemented in various cognitive domains of memory,executive function,information processing speed,et al. Memory:World health organization university of california-los angeles audito ryverbal learning test (WHO-UCLA AVLT) was conducted for auditory memory,and simplified Rey Osterrieth Complex Figure Test (ROCFT) was conducted for visual memory. Executive function:brief Stroop test interference section (C section) was conducted for the ability to control interference, semantic category verbal fluency test was conducted for flexibility of thinking, Wechsler Adult Intelligence Scale-Revised in China (WAIS-RC) picture arrangement subtest (1,3,5,7items) was conducted for logical order capacity,WAIS-RC digital the breadth Daobei sub quizzes was conducted for working memory, and California card Sorting Test was conducted for concept formation and conversion capabilities and abstract reasoning ability.Speed of information processing: the Stroop tests color block section (A section) and WAIS-RC digit symbol subtest was conducted.Results①Compared with control group, in therapy group, MMSE scores before CAS,1month and6months after CAS, MoCA scores before CAS(19.39±2.17) and1month after CAS(19.51±1.99) and the scores of Cube Copying before CAS, Alternating Trail Making Test, attention and delayed recall before CAS,1month after CAS and Clock Drawing before CAS,1month and6months after CAS all lowered obviously.There were statistical differences(p<0.05or p<0.01). Compared with before CAS, in therapy group, MMSE scores and MoCA scores6months,1year and2years after CAS,the scores of Alternating Trail Making Test2years after CAS, Cube Copying and Clock Drawing1year and2years after CAS and attention and delayed recall6months,1year and2years after CAS all increased obviously. There were statistical differences (p<0.05or p<0.01).②In WHO-UCLA AVLT, the scores of immediate recall, long-time delayed recall and recognition before CAS and short-time delayed recall before CAS and1month after CAS were all worse than those of control group and the scores of immediate recall1year after CAS were better than those of control group. In ROCET, the scores of immediate recall and long-time delayed recall before CAS were all worse than those of control group. There were statistical differences(p<0.05or p<0.01). The scores in California card sorting test of executive function and WAIS-RC digit span backwards subtest at every time point before and after CAS and in semantic category verbal fluency test before CAS were all worse than those of control group. There were statistical difference (p<0.05or p<0.01). The scores in the Stroop tests (A section) and WAIS-RC digit symbol subtest of speed of information processing had no obvious changes. Therewas no statistical difference(p>0.05). In WHO-UCLA AVLT, the scores of immediate recall and long-time delayed recall6months,1year and2years after CAS and the scores of short-time delayed recall at every time point after CAS were all better than those of before CAS. In ROCFT, the scores of immediate recall, recognition1year and2years after CAS and long-time delayed recall6months,1year and2years after CAS were all better than those of before CAS.There was statistical difference (p<0.05or p<0.01). The scores of semantic category verbal fluency test and WAIS-RC digit span backwards subtest6months,1year and2years after CAS and WAIS-RC card sorting test1year and2years after CAS were all better than those of before CAS. There was statistical difference (p<0.05or p<0.01).③The MoCA score was regarded as dependent variables, and age, total cholesterol, smoking, interventional therapy and meaningful variables (diabetes, high blood pressure, low levels of education) by single factor analysis (P<0.05) were regarded as independent variables. And Logistic Regression Analysis was conducted. The result showed that MoCA scores has correlation with age, high blood pressure and low levels of education and no correlation with diabetes, interventional treatment in therapy group.Conclusion①In acute stage of patients with LI(with in1week), most cognitive impairment was severe,but the speed of information processing is basically unaffected.②Cognitive impairment in patients with LI is improved1year after CAS, and visuospatial function, attention and delayed recall are significantly improved. The mechanism may be associated with the improvement of chronic cerebral insufficiency.③MoCA for mild cognitive impairment has better sensitivity and specificity than MMSE, but how to apply MoCA better need to combine the characteristics of the Chinese people.④Old age, low education levels and high blood pressure are independent risk factors for cognitive impairment in patients with LI.⑤Cognitive functions in patients with LI are significantly improved after CAS, but CAS is not independent protective factors for cognitive functions in patients with LI.