| Background: with the further aging of the Chinese population,the prevalence of elderly-related diseases is gradually increasing.The daily life of seniors is severely affected by their cognitive dysfunction,which puts a huge burden on the society and the family of the elderly.The ischemic vascular cognitive dysfunction caused by the Subcortical Ischemic Vascular Disease(SIVD)is the most common subtype of vascular cognitive dysfunction.There is a high prevalence of vascular dementia in China,while few studies are on SIVD and inadequate epidemiological studies on cognitive dysfunction caused by SIVD.Compared to Alzheimer’s disease,the cognitive dysfunction caused by SIVD can be cured to some extent.Defining the characteristics of risk factors and cognitive decline is clinically meaningful for the early recognition,diagnosis and treatment of the cognitive dysfunction caused by SIVD.Purpose:(1)To define the characteristics of neuropsychological changes and cognitive decline in patients with SIVD and explore the early indicators for rapid diagnosis and identification of SIVD.(2)Explore the influencing factors of cognitive function decline in SIVD patients,providing a theoretical basis for the early prevention of SIVD.Methods: The results was tested by imaging.A total of 497 patients with SIVD were included in the study based on the diagnostic criteria proposed by Erkinjuntti.Patients were divided into the Group NCI,the Group MCI and the Group Va D according to the degree of their cognitive decline.The trained investigators recorded the patients’ general demographic data and blood test results,gave neuropsychological tests to the patients and evaluated the activities of daily living of the patients.Experienced neurologists assessed the patients’ imaging results,the pathological changes of the white matter,the number of lacunar infarcts,and the severity of the cerebral atrophy.According to the pathological changes of the white matter,patients were divided into the Mild to Moderate Group and the Severe Group.Characteristics of cognitive function changes in patients with different pathological changes of the white matter were clarified.By using the single factor analysis,multiple linear regression and structural equation models,we identified the characteristics of neuropsychological changes and cognitive decline in SIVD patients and explored the influencing factors of cognitive decline in SIVD patients.Results:(1)Compared to the Group NCI,the cognitive function of each cognitive domain in the Group MCI and the Group Va D was severely impaired,and the activities of daily living also showed a significant decline(P<0.05);compared to the Group MCI,the Group Va D showed a severe decline in each cognitive domain function and the activities of daily living(P<0.05);(2)In the comparison of the blood test results,the blood Hcy level,CRP level and the interleukin-6 level in the Group Va D were higher than those in the Group NCI and the Group MCI(P<0.05).There was no significant difference in the above results between the Group NCI and the Group MCI.The folate level of the Group Va D was lower than that of the Group MCI(P<0.05),but there was no significant difference from the Group NCI(P>0.05);(3)ARWMC scores in the three groups were statistically significant by evaluating and comparing the imaging results.The ARWMC score of the Group Va D was(12.06±6.64)points,which was higher than that of the Group MCI(9.26±5.56)and the Group NCI(7.75±5.41)(P<0.05).The difference between the Group MCI and the Group NCI was statistically significant(P<0.05).The ARWMC scores in each brain area of the Group Va D were higher than those of the other two groups(P<0.05).The frontal lobe ARWMC scores in the Group MCI were higher than that in the Group NCI(P<0.05).There was no significant difference in the ARWMC scores in the rest of the brain areas of the Group MCI and the Group NCI(P>0.05);the difference in the number of LI lesions in the three groups was statistically significant.The number of LI lesions in the Group Va D was higher than that in the Group MCI and the Group NCI,and the number of LI lesions in the Group MC was higher than that of the Group NCI(P<0.05).Except for the temporal lobe,the LI counts in each brain area of the Group Va D were higher than that of the other two groups(P<0.05).The LI counts in the basal ganglia of the Group MCI was higher than that of the Group NCI,and the counts of the LI in the rest of the brain areas were not significantly different between the Group NCI and the Group MCI(P>0.05);the brain atrophy visual score of the Group Va D group was(14.23±6.6)higher than that of the Group MCI and the Group NCI(P<0.05).There was no significant difference between the Group MCI and the Group NCI(P>0.05);(4)The orientation,attention,calculation and language ability scores of WMLs patients with the severe frontal lobe,parieto-occipital lobe,subtentorial area and basal ganglia affected were lower than those of the Mild to Moderate patients,and the difference was statistically significant(P<0.05).The recall ability scores of WMLs patients with severe subtentorial area affected were lower than those of Mild to Moderate patients,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the evaluation of various cognitive domains between WMLs patients with temporal lobe severely affected and WMLs patients with temporal lobe mildly or moderately affected(P>0.05).Conclusions:(1)SIVD patients suffer a cognitive function decline in the whole cognitive domain,mainly in orientation,attention and calculation,and language ability,while the memory decline is relatively slight;(2)The WMLs in SIVD patients are mainly in the frontal lobe,the parietal-occipital area and the basal ganglia area.The severity of the WMLs is related to cognitive decline;the number of the LI infarcts,especially the number of infarcts in the basal ganglia,in SIVD patients is related to the decline of the cognitive function;SIVD patients are often with brain atrophy,and the severity of the brain atrophy is related to the decline of the cognitive function;(3)The ARWMC score,the number of the lacunar infarction lesions,the brain atrophy visual score,the blood Hcy level,the CRP and the IL-6 were associated with the decline of cognitive function in patients with SIVD... |
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