Characteristics Of Cognitive Impairment And White Matter Lesions In Patients With Vascular Parkinsonism:A Pilot Study

Background:Vascular Parkinsonism(VaP)is a clinically common secondary parkinsonian syndrome,which cognitive impairment is obvious.However,while clinical features have been previously studied,cognitive function in VaP has yet to be fully understood.With the in-depth study of VaP,it is very important to clarify the characteristics of cognitive impairment in VaP and explore its relationship with white matter lesions.Objective:The aim of our study was trying to explore the clinical risk factors,the clinical characteristics of cognitive impairment and its relationship with white matter lesions in patients with VaP.Method:(1)30 VaP patients,30 Parkinson’s Disease(PD)patients,and 32 control subjects were recruited to compare the clinical data,anamnesis,personal history,and some blood biochemical indexes of the three groups of subjects.Then,VaP patients were divided into VaP with Mild Cognitive Impairment(VaP-MCI)group,VaP with Dementia(VaP-D)group and VaP with Normal Cognition(VaP-NC)group.The above data were compared in three groups attempting to explore the risk factors of cognitive impairment in VaP patients.(2)We evaluated 30 patients with VaP,30 with PD and 15 healthy controls(HC)with similar age,sex and education distribution.All subjects underwent detailed neuropsychological tests included analysis of global cognitive function and five cognitive domains of attention and working memory,executive function,language,memory and visuospatial function.The Scheltens semiquantative rating scale was used to evaluate the locations and extent of white matter hyperintensities(WMH)of magnetic resonance imaging in VaP patient.Spearman correlation analysis was used to explore the correlation between cognitive function and white matter lesions in patients with VaP.Results:(1)VaP patients exhibited older age,lower education years,higher frequency of stroke history,lower folate level and higher homocysteine level than control subjects,Three groups subjects had no statistically significant differences in gender,BMI,frequency of hypertension,diabetes,hyperlipidemia,smoking and alcohol consumption.The years of education in patients with VaP-NC were significantly higher than those in VaP-MCI and VaP-D group.(2)VaP,PD and HC subjects had no significant difference in age,gender and education.The global cognitive function and each cognitive domain in VaP group were significantly decreased than those in HC group(p<0.05).Compared with patients in PD group,patients in VaP group experienced more significant declines in global cognitive function,attention and working memory and language domains(p<0.05).(3)In the VaP group,WMH scores on anterior horns of the lateral ventricles,along the lateral ventricles,frontal lobe and basal ganglia were significantly higher than those in PD and HC groups,while WMH scores on parietal lobe was also significantly higher than those in PD group.(4)The overall WMH score of VaP patients was negatively correlated with the global cognitive function.Periventricular hyperintensities(PVH)was negatively correlated with global cognitive function,executive function,memory,and visuospatial function.PVH in anterior horns of the lateral ventricles was negatively correlated with global cognitive function,attention and working memory,executive function,memory,and visuospatial function,while PVH in posterior horns of the lateral ventricles was only negatively correlated with global cognitive function,memory,and visuospatial function.As for the deep white matter hyperintensities(DWMH),we found that DWMH in parietal lobe was negatively correlated with global cognitive function,executive function,and visuospatial function.What’s more,basal ganglia hyperintensities was negatively correlated with memory function.Conclusions:(1)Older age,history of stroke,lower years of education,hyperhomocysteinemia,and folate deficiency may be the risk factors for VaP.Educational level may affect the cognitive reserve of VaP patients.The higher the educational level of VaP patients might be less likely to suffered from cognitive impairment.(2)VaP patients exhibited comprehensive cognitive dysfunction,including five cognitive domains of attention and working memory,executive function,language,memory and visuospatial function.Compared with PD patients,VaP group suffered more damage in attention and working memory and language domains.(3)VaP patients exhibited extensive white matter hyperintensities,especially in anterior horns of the lateral ventricles,along the lateral ventricles("band"),deep white matter in frontal and parietal lobe and basal ganglia.PVH in VaP patients may be related to the impairment of global cognitive function and multiple cognitive domains.DWMH in parietal lobe may be related to impairment of global cognitive function,executive function,and visuospatial function.Basal ganglia hyperintensities may be negatively related to memory function.