Correlation Between The Total MRI Burden Of Cerebral Small Vessel Disease And Post Stroke Depression In Patients With LAA Cerebral Infartion

Objective:To investigate the correlation between the total cerebral small vessel disease(CSVD)score and post stroke depression(PSD)in patients with large artery atherosclerosis(LAA)cerebral infarction.Methods:A total of 232 patients with acute ischemic stroke of LAA type were consecutively recruited in Department of Neurology,Affiliated Hospital of Qingdao University from October 2017 to September 2019.Demographic data(age,sex,years of education),vascular risk factors(hypertension,diabetes,coronary heart disease and hyperlipidemia)and lifestyle(smoking and drinking)were collected.The National Institute of Health Stroke Scale(NIHSS)was used to assess neurological deficits of enrolled patients.Imaging examination of brain structure and cerebral vessels were performed within 1 week of admission.The Hamilton depression scale(HAMD)and Hamilton anxiety scale(HAMA)were used to evaluate the Depression and Anxiety of the patients at 14 days and 90 days after onset.The modified Rankin Scale(mRS)was used to evaluate functional prognosis at 90 days after onset.The total CSVD score was used to represent the total MRI burden of cerebral small vessel disease.The total CSVD score included four MRI features:lacune,WMH,CMB and PVS.According to the“total CSVD score”,the enrolled patients were divided into 5 categories:0,1,2,3 and 4 points.The risk factors of the total MRI burden of CSVD and PSD were analyzed.The correlation between the total CSVD score and PSD in patients with LAA cerebral infarction was investigated by multivariable analysis.Results:A cohort of 216 patients were followed over a 3-month period after stroke with complete data and all patients were eventually included in the analysis.(1)Statistical analysis was performed on the general data of the five categories of patients.The results showed that there were significant differences in age,the baseline NIHSS score,the proportion of diabetes,the HAMD score at 14 days and 90 days after stroke,the HAMA score at 14 days and 90 days after stroke,and the mRS score at 90 days after stroke(P<0.05).(2)Spearman rank correlation analysis showed that age,the baseline NIHSS score,the HAMD score at 14 days and 90 days after stroke,the HAMA score at 14 days and 90 days after stroke,and the mRS score at 90 days after stroke were positively correlated with the total CSVD score(r_s>0,P<0.05).(3)The linear regression models were established for the total CSVD score,the HAMD score and the HAMA score.The results showed that the higher of the total CSVD score was,the higher of the HAMD score and the HAMA score were(P<0.05).After adjusting for confounding factors,the results were still significant(P<0.05).(4)Compared with the non-PSD group,years of education in the PSD group was significantly lower,while age,the baseline NIHSS score,the proportion of diabetes,the proportion of lacune,the proportion of WMH,the proportion of CMB,the total CSVD score,the HAMA score at 90 days after stroke,and the mRS score at 90 days after stroke were significantly higher in the PSD group.The differences were statistically significant(P<0.05);Multivariate logistic regression analysis found that the years of education,the baseline NIHSS score,the total CSVD score and the HAMA score at 90 days after stroke were identified as the independent risk factors for PSD(P<0.05).Conclusions:(1)Age and diabetes are important risk factors for the total MRI burden of CSVD in patients with LAA cerebral infarction.(2)The years of education,the baseline NIHSS score,the total CSVD score and the HAMA score at 90 days after stroke are independent risk factors for PSD in patients with LAA cerebral infarction.(3)The total MRI burden of CSVD is closely related to the occurrence of PSD in patients with LAA cerebral infarction.