Clinical And Imaging Study On Cerebral Small Vessel Disease Signs Of Cognitive Impairment Groups With Different Severity

Objective: To investigate the intracerebral enlarged perivascular spaces(EPVS)and white matter hyperintensities(WMH)among cognitive impairment groups with different severity,and to analyze the relationship between EPVS,WMH and cognitive function.Using neuropsychological evaluation and magnetic resonance imaging to preliminarily screen out people diagnosed with subjective cognitive decline(SCD1)and subtle cognitive decline(SCD2).Methods: 48 people diagnosed with subjective cognitive decline(SCD1),43 people diagnosed with amnestic mild cognitive impairment(aMCI),44 people diagnosed with Alzheimer’s disease(AD)and 43 normal controls(NC)were included in our study.Multiple neuropsychological tests and 3.0T magnetic resonance imaging were conducted.EPVS in the basal ganglia and centrum semiovale were counted and graded using subjective visual rating.We also used subjective visual rating to grade periventricular white matter hyperintensities(PVH)and deep white matter hyperintensities(DWMH).Kruskal-Wallis test and Kolmogorov-Smirnov Z test were used to analyze the inter-group difference.Relationship between the scores of EPVS,WMH and cognitive function were analyzed using Spearman’s Correlation analysis and Partial correlation.29 people diagnosed with SCD1,25 people diagnosed with SCD2 and 50 age-and-sex-matched normal controls were included in the study.Multiple neuropsychological tests and 3.0T magnetic resonance imaging were conducted.We used receiver operating characteristic curve(ROC)to evaluate the diagnostic ability of neuropsychological tests and WMH location to distinguish SCD2,SCD1 and NC.Then we conducted voxel-based lesion symptom mapping(VLSM)to analyze the correlation between WMH location and SCD1,SCD2.Result:1.EPVS scores in the centrum semiovale in AD group(3.18±0.58)were significantly higher than that in SCD group(2.60±0.64)(P<0.01),a MCI group(2.77±0.81)(P<0.05)and NC group(2.56±0.77)(P<0.01).EPVS scores were positively associated with age(P<0.05).After controlling age,gender and years of Education,the partial correlation result showed that EPVS scores in the centrum semiovale were negatively correlated with MMSE,MoCA-B(r=-0.30,-0.37,P=0.000),were negatively correlated with AVLT-N5,N7 scores(r=-0.241,P =0.002;r=-0.275,P =0.000),were negatively associated with BNT scores(r=-0.257,P=0.001).No difference was found in EVPS in the basal ganglia.2.The scores of PVH and DWMH in AD group were higher than those in SCD group and NC group(P<0.05).No significant difference was observed in PVH and DWMH scores between a MCI group and NC group(P>0.05).PVH and DWMH scores were both positively correlated with age(r = 0.527,0.387,P= 0.000).After controlling the influence of age,gender and education level,the partial correlation analysis revealed that PVH score was negatively correlated with MMSE and MoCA-B scores(r=-0.255,P= 0.01;r=-0.313,P= 0.000),AVLT-N5 score(r=-0.214,P=0.006),AFT and BNT score(r=-0.202,P=0.01;r=-0.251,P=0.001),was positively correlated with the STT-A score(r=0.286,P=0.000).DWMH score was negatively correlated with MMSE and MoCA-B score(r=-0.246,P=0.002;r=-0.330,P=0.000),negatively correlated with AVLT-N5,(r=-0.266,P= 0.001),negatively correlated with AFT and BNT score(r=-0.245,P= 0.002;r=-0.263,P=0.001),and positively correlated with STT-A score(r=0.331,P=0.000).3.The ROC evaluating the diagnostic ability of neuropsychological tests to distinguish group SCD2,SCD1 and NC showed that combining MoCA-B、AVLT-N5、BNT three tests to distinguish group SCD2,the AUC value was 0.93.Using ROC evaluating the WMH location revealed that WMH in bilateral caudate nucleus to distinguish SCD1,the AUC value was 0.70.VLSM showed the voxel location of the significant correlation between WMH and SCD1.The left caudate nucleus had the highest statistical correlation with SCD1(test value was 3.25),the next was the right caudate nucleus(test value was 2.24).Conclusion: EPVS scores in centrum semiovale,PVH and DWMH scores were significantly higher in AD group than in other groups.EPVS in the centrum semiovale was negatively correlated with general cognitive function,memory and language functions.No difference was found in EVPS in the basal ganglia among the four groups.EVPS in the basal ganglia was not associated with cognitive function.PVH and DWMH were negatively correlated with general cognitive function,memory,language and executive function.SCD2 group could be screened out from SCD1 group,SCD2 group and NC group by combining MoCA-B、AVLT-N5 and BNT.Then the WMH in the bilateral caudate nucleus could help distinguish SCD1 group and normal control group.