Research On Influencing Factors Of Total Cerebral Small Vessel Disease Burden In Middle-aged And Elderly People And Its Relationship With Cognitive Function

Objective: To explore the influencing factors of total cerebral small vessel disease(CSVD)burden and its relationship with cognitive function in middle-aged and elderly people.Methods: A total of 204 middle-aged and elderly patients who attended the Hebei General Hospital from September 2016 to December 2018 were selected.Demographic and clinical data of the patients were collected,and the total CSVD burden was evaluated based on imaging performance(0-4 points).According to the score,120 cases were divided into mild-to-moderate group(0-2 points)and 84 cases of severe group(3-4 points).Meanwhile,mini mental state examination(MMSE)and Montreal cognitive assessment scale(Mo CA)were used to assesses patients’ cognitive function.And then they were divided into cognitive normal group(63 cases)and cognitive impairment group(141 cases)according to the results.The univariate analysis was carried out by independent sample T test,Mann-Whitney U test,and χ2 test,and logistic regression was used for the factors affecting the total CSVD burden and cognitive impairment.Spearman correlation analysis and linear regression were adopted to analyze the relationship between the total CSVD burden and overall cognition and each cognitive domain.Results:1.Compared with the mild-to-moderate group,the severe group appeared older,lower levels of total cholesterol,high density lipoprotein(HDL),and low density lipoprotein.Men,hypertension,previous history of cerebral infarction,smoking composition were higher,and the composition ratio of hyperlipidemia is lower(P <0.05).2.Binary logistic regression analysis showed that age(OR: 1.039,95% CI: 1.004-1.074),hypertension(OR: 2.077,95% CI: 1.005-4.289),history of previous cerebral infarction(OR: 2.971,95 % CI: 1.474-5.987)were independent risk factors for severe CSVD burden,while a high level of HDL(OR: 0.113,95% CI: 0.014-0.892)was a protective factor.3.Patients who were divided to cognitive impairment group got older,presenting lower levels of SUA,lower years of education,higher composition ratio of previous history of cerebral infarction and severe total CSVD burden(P < 0.05).4.After adjusting for other risk factors,the severe total CSVD burden(OR:2.091,95%CI:1.014-4.311)was an independent risk factor for cognitive impairment(P <0.05).5.Spearman correlation analysis showed that the total CSVD burden was significantly negatively related to MMSE,Mo CA and its sub-item including visual space and execution,attention and calculation,language,delayed recall,and orientation(P <0.05).6.Linear regression was performed to compare the total CSVD load score between 1-4 points and 0 points,respectively,on the overall cognition and each cognitive domain.The results showed that when comparing 1points with 0 points,the delayed recall score decreased significantly by 0.65 points(P <0.05).And at 2 points,the delayed recall score was 0.783 points lower than 0 points(P <0.05).While compared with 0 points,people who got 3 points showed significantly lower in the MMSE total score,Mo CA total score and its sub-items in terms of visual space and execution,attention and calculation,language,and delayed recall scores(P <0.05).And patients with 4 points showed significantly decrease in the naming and orientation besides above items in 3 points(P <0.05).Conclusions:1.Age,hypertension,and previous history of cerebral infarction are possibly independent risk factors for the severe total CSVD burden,while a high level of HDL may be a protective factor.It is consistent with individual CSVD markers.Therefore,the management of blood pressure in patients with CSVD and the prevention of cerebral infarction should be concerned.2.The severe total CSVD burden maybe an independent risk factor for cognitive impairment.3.The total CSVD burden is negatively related to MMSE,Mo CA and its sub-items including visual space and execution,attention and calculation,language,delayed recall,and orientation.4.Comparing the total CSVD burden to 1-4 points with 0 points respectively,delayed recall was impaired when it counts 1-2 points,and overall cognition and multiple cognitive domains were impaired in the severe group.Therefore,we should pay attention to the intervention of CSVD early.Meanwhile,the total CSVD burden can be used instead of individual CSVD markers for risk assessment and prognosis judgment clinically.