Cognitive Impairment In Patients With Multiple Lacunar Infarctions

Objective:To investigate the rate of cognitive impairment in patients with multiple lacunar cerebral infarctions,the characteristics of impairment in cognitive domain,the relationship between cognitive impairment and site,number of multiple lacunar infarctions.Methods:A total of 90 patients with multiple lacunar infarctions diagnosed in the Second Hospital of Lanzhou University from October 2015 to 2016 in October were recruited in the study.The patients were divided into three subgroups according to the number of infarctions and four subgroups according to the location of infarctions,including the basal ganglia group,the centrum ovale group,the thalamus group and the cerebellum / brainstem group.Thirty healthy volunteers in the same period were recruited in the control group.The age,gender and educational level were compared between the case group and control group.Subjects of the case and control groups underwent 3.0T head MRI,Carotid Duplex Ultrasound,TCD,ECG,blood lipids,blood glucose,liver and kidney function and other laboratory tests.The infarction location and number of patients were recorded.The Mini Mental State Examination(MMSE)and the Montreal Cognitive Assessment(MoCA)were used to evaluate cognitive function of the two groups.Results:(1)A total of 90 patients with multiple lacunar cerebral infarctions were enrolled,there were 41 patients with cognitive impairment and the rate of cognitive impairment was 45.56%;There were 7 healthy subjects with cognitive impairment in the control group and the rate was 23.33%.(2)The MoCA scores in the case group and the control group were 21.14±2.33,24.14±0.90,there was statistical difference between the two groups(P<0.05).Visual space and executive function,language and delayed memory ability scores of the case group were respectively 3.61±1.36,1.93±0.81,2.84±1.24,control group were respectively 4.17±0.49、2.14±0.69、3.27±1.13,the differences between the control group and case group were statistical(P<0.05).(3)The scores of MMSE and MoCA were 24.14±4.52,21.00±5.27 in the number of infarctions ranged from 2 to 5,the scores were 24.00±3.19,20.78±3.70 ranged from 6 to 9,and were 21.10±6.56,17.67±6.87 with the number of infarctions greater than or equal to 10.The MMSE,MoCA scores of the number of infarctions ranged from 2 to 5 were higher than those of ranged from 6 to 9 and greater than or equal to 10,the MMSE,MoCA scores of the number of infarctions ranged from 6 to 9 were higher than those of greater than or equal to 10.The MMSE,MoCA scores were least when the number of infarctions greater than or equal to 10,there were statistical differences between the two groups(P<0.05).The number of infarctions was negatively correlated with the scores of MMSE and MoCA(r=-0.57,-0.36,P<0.05).(4)The semi oval center mainly caused visual space,executive ability,abstract and language impairment;basal ganglia focus on visual space and executive ability,attention,language,abstraction and delayed memory ability.In thalamic infarction subgroup,the domains of visual space and executive ability,language,abstraction,attention disorder were mainly impaired.Language function and delayed memory ability were mainly impaired in the cerebellum/brainstem infarction subgroup(P<0.05),there were signif icant differences in visual space and executive ability,attention,abstraction,and delayed memory ability between two groups(P<0.05).Conclusions:Multiple lacunar infarctions lead to cognitive impairment,mainly in domains of visual space,executive ability,language and delayed memory ability.Cognitive impairment is more severe with the increase of infarct number.The different infarction sites are different in cognitive impairment domains.