Analysis Of Cognitive Impairment In Patients With Different Degree Of White Matter Lesions

Objective: To investigate the characteristics of cognitive impairment in patients with varying degrees of white matter lesions.Methods: 70 patients who were hospitalized in the department of neurology of the People’s Hospital of Liaoning Province from March 2016 to October 2017 and met the WML diagnostic criteria were observed(WML group).Ten non-WML patients who were hospitalized at the same time and matched in age,sex,and education were selected as controls(control group).According to the MR performance of the head,patients were divided into control group,mild WML group,moderate WML group,and severe WML group using Fazekas score criteria.Collect patient’s clinical data.Neuropsychological scales were used to evaluate cognitive function,memory,executive function,attention,and visual space functions in different WML patients: MMSE and MoCA scale were used to evaluate the patients’ overall cognitive function,Rey auditory verbal learning test was used to evaluate the immediate memory,delayed memory and re-recognition ability,trail making test and Stroop color-word test were used to evaluate the patients’ executive function which including the information processing speed,reasoning and conversion ability and inhibition of interference,digit span test(positive sequence)was used to evaluate the patients’ attention,clock drawing test and block design were used to evaluate patients’ visual spatial function.Scale scores are expressed as mean ± standard deviation(?x ± s).The differences of cognitive impairment in WML group were compared.Results:1.Evaluation of Cognitive Function in WML Patients: The WML group’s overall cognitive function,memory(immediate memory,delayed memory),attention,visual spatial function scores were significantly lower than the control group(all P<0.05),and the time needed to complete the executive function(information processing speed,reasoning conversion ability and the interference suppression ability)test were significantly longer(all P<0.05).There was no significant difference in re-recognition ability scores between the two groups(P>0.05).2.Comparison of cognitive function in different degrees of WML patients: The degree of cognitive impairment in different degrees of WML patients is also different.Mild group: The speed of information processing,reasoning and conversion ability were significantly prolonged when compared with the control group(all P<0.05),that is,the central molecule of the executive function was affected.Moderate group: In addition to the above-mentioned executive function being affected(P<0.05),attention and visual space function scores(block tests)also decreased significantly(P<0.05).Severe group: memory,executive function,attention,and visual space function were significantly decreased compared with the other three groups(all P<0.05).Among them,immediate memory,short-term delayed memory,long-term delayed memory score in memory were significantly lower than those in other groups(all P<0.05);the ability to suppress interference in the executive function was significantly longer in the milder WML group(P<0.05).3.The correlation between WML degree and cognitive function : the degree of WML was negatively correlated with overall cognitive function,memory(including immediate memory,delayed memory,and recognition ability),attention,and visual spatial function score(r=-0.348 to-0.649,P<0.05),and was positively correlated with the time needed to complete the executive function.(including information processing speed,reasoning conversion ability and the interference suppression ability)test(r=0.447-0.545,P<0.05).Conclusion:1.WML can cause a decline in overall cognitive function,impairing multiple cognitive domains such as memory,executive function,attention and visual spatial function.2.Cognitive dysfunction in WML patients is related to their severity,that is,the extent of impairment of the cognitive domain increases with the severity of WML.Patients with mild WML manifested as executive dysfunction,memory,attention,and visual spatial function remained;moderate and severe WML patients may suffer from impairment of attention and visual space;patients with severe WML may have memory(immediate memory,short-term delayed memory,long-term delayed memory)decline,a wider range of cognitive impairment,can cause almost all cognitive domain functions,including memory,executive function,attention and visual space function.3.The executive dysfunction of WML patients appeared earlier and more prominent.The speed of information processing,reasoning and conversion ability in executive functions were impaired earlier than the ability to suppress interference.The ability to suppress interference was preserved in moderate WML.The decline of memory is only seen in patients with severe WML.The visual spatial dysfunction is seen in patients with moderate to severe WML,that is,there may be some threshold value in impairment of memory and visual spatial function.Only when WML reaches a certain level will memory-related,visual-spatial dysfunction-related symptoms occur.4.In scale assessment,the MoCA scale has a higher sensitivity than the MMSE scale in the assessment of overall cognitive impairment,and the building block scale has a higher evaluation of visual spatial dysfunction than the clock drawing test scale.