| Cerebrovascular disease is one of the most common neurological diseases in Department of Neurology, and stroke is a major cause of disability. There are 30% patients in 3 months after stroke could have serious symptoms of dementia, 50%-75% stroke patients may have cognitive dysfunction after stroke, and the risk of cognitive dysfunction in patients with stroke at least is nearly 10 times of non-stroke patients. Cerebral small vessel disease is the most common clinical brain vascular diseases, often lead to cognitive dysfunction, the main disease types including brain white matter damage, lacunar infarction and micro hemorrhage. Cerebral white matter lesions was first proposed in 1978 by Hachinski, which is caused by a variety of reasons or subcortical periventricular white matter punctate or patchy changes to diffuse bilateral lateral ventricle and semi oval spots center area of the cerebral white matter characteristics. Cerebral white matter lesions are common in neuroimaging, abnormal imaging manifestations, can lead to cognitive impairment in dementia, cerebrovascular disease, etc., can also be seen in normal elderly.Carotid artery stenosis can lead to atherosclerosis, cerebral ischemia, hypoxia, chronic damage of brain tissue, brain white matter lesions, andthen the patients have cognitive dysfunction. Brain white matter damage is believed to be caused by one of the independent risk factors of vascular cognitive impairment, especially affect the patient’s executive ability, has been a number of studies have confirmed. Since the carotid artery stenting has been applied to the treatment of carotid artery stenosis, with its unique advantages, has become the treatment of carotid artery stenosis important new treatment method. Japan has found 1 cases of right internal carotid artery stenosis aged patients with carotid artery stent, right cerebral white matter hyperintensities volume significantly reduced, suggesting that the improvement of carotid artery stenosis can improve the blood supply of cerebral white matter lesions, but also further support the correlation between carotid artery stenosis and cerebral white matter lesions.We assume that the cerebral white matter damage can cause the decline of carotid artery stenosis in patients with cognitive function in a certain extent, and white matter damage severity, cognitive decline and the severity of white matter damage in different parts, the characteristics of cognitive impairment in different; carotid artery stenting treatment can improve cognitive function in patients with cerebral white matter damage, the more severe with the damage of the white matter, the better improvement of the cognitive function level; patients with carotid artery stenosis in correlation with the level of fatigue after carotid stenting with cognitive impairment level, carotid artery stenting treatment can improve the cognitive function of patients, but also can improve the fatigue of patients. In this study, patients with cerebral vascular disease were recruited, and carotid angioplasty and stenting for carotid stenosis caused by the factors of white matter lesions with cognitive function of the brain and related effects, and reveal the stent influence factors of cerebral white matter changes, to explore the relationship between the changes and the changes of cognitive function and the possible mechanism. Part I: The relationship between cognitive impairment and brain white matter lesions and the characteristics of cognitive function in patients with carotid artery stenosisObjective: To explore the characteristics of cerebral white matter lesions in patients with carotid artery stenosis, and the effect of cerebral white matter lesions on cognitive functionMethods: We performed a prospective study of 160 patients with carotid artery stenosis, who completed a standardized neurological assessment, including demographic and clinical information and a full neuropsychological battery.Results: WML- mild group, moderate group and severe group have significant difference in NIHSS, MMSE, Mo CA, SDMT, LLT, RCFT-delayed recall and digit span(P<0.05). Compared with no brain white matter damage group, there was significant difference in the total score of Mo CA, executive function and memory of mild cerebral white matter damage group(P<0.05), moderate cerebral white matter lesion group decreased significantly in the MMSE total score, Mo CA total score, executive function and memory function(P<0.05), Severe WML group decreased significantly in the MMSE score, Mo CA score, executive function, memory, attention and other functions(P<0.05), moderate cerebral white matter damage group in the total score of Mo CA, memory decreased significantly compared with mild cerebral white matter lesion groups(P<0.05), severe cerebral white matter damage group in MMSE total score, Mo CA total score, memory, attention compared with moderate cerebral white matter lesion were significantly decreased(P<0.05). The WML-DWMC group had significantly lower score in cognition than the WML-PVWMC. The WML-PVDWMC group had significantly lower score in cognition than the WML-PVWMC.Conclusions:(1) white matter lesions can cause the patients’ cognitive decline in a certain extent. The severe of white matter lesion, the cognitive decline in patients with more serious.(2) With the severity of white matter lesions, the overall cognitive function of patients was decreased gradually.(3) Different parts of the lesion, the cognitive function of the damage area is also different.(4) Patients with mixed type lesions and deep white matter lesions, the cognitive decline more serious than periventricular white matter damage.Part II: Long term effect of carotid artery stenting on cognitive function in patients with carotid artery stenosis Correlation between changes of cognitive function and cerebral white matterObjective: The effect of carotid artery stenting on the cognitive function in patients with carotid artery stenosis and the relationship between the changes of cerebral white matter structure.Methods: We performed a prospective study of 118 patients with carotid artery stenosis, who completed a standardized neurological assessment, including demographic and clinical information and a full neuropsychological battery, and follow up at 3 months, 6 months, 12 months, and 18 months after vascular intervention.Results: After 3 months, the cognitive function of the patients was not significantly improved(P>0.05), at the 6th month, general cognitive ability, the symbol digit conversion, the Boston naming, complex image rendering, vocabulary learning, complex image delay memory, digit span function were improved significantly(P<0.05), in the first 12-18 months, the cognitive function of the patients was improved(P<0.05), and the deep brain white matter semi quantitative score significantly reduced(P<0.05). The elderly(over 70 years of age), hypertension, diabetes mellitus may be an independent risk factor for cognitive impairment after carotid stenting(P<0.05-0.01).Conclusions:(1) After carotid artery stenting for 6 months, the cognitive function of patients with carotid stenosis was significantly improved.(2) With the prolongation of stent implantation time, the cognitive function of the patients in the group was gradually improved in many fields, and this improvement can be sustained for eighteenth months after stent implantation.(3) Carotid artery stenting can partly reverse the cerebral white matter lesions have lesions, the change in the deep brain white matter is more obviously.(4) The elderly(over 70 years of age), hypertension, diabetes mellitus may be an independent risk factor for cognitive impairment after carotid stenting.(5) The improvement of cognitive function after carotid artery stenting does not depend on the baseline of the white matter lesions, and patients with more severe brain white matter damagemay have the greater the cognitive benefit from the treatment.Part III: Study on the correlation between fatigue and cognitive function after stent implantation in patients with carotid artery stenosisObjective: To investigate the relationship between fatigue and cognitive function in patients with carotid stenosis after stent implantation.Methods: We performed a prospective study of 160 patients with carotid artery stenosis, who completed a standardized neurological assessment, including demographic and clinical information and a full neuropsychological battery and FS-14, FSS-9, and follow up at 6 months after vascular intervention.Results: FS-14 and FSS-9 scores were significantly decreased(P<0.001) in 6 months after surgery compared with preoperative, Preoperative patients with MMSE, Mo CA score and FS-14 and FSS-9 score independent(P>0.05), at 6 months after operation, the FS-14 and FSS-9 scores were negatively correlated with MMSE and Mo CA.Conclusions: After carotid artery stenting, the fatigue status of patients with carotid artery stenosis was improved, cognitive function and fatigue status scores were negatively correlated. |
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