A Correlative Study Of Vascular Risk Factors,Cerebrovascular Morphology And Collateral Circulation In Patients With Vascular Cognitive Impairment No Dementia

Background Vascular cognitive impairment no dementia(VCIND)is an early stage of vascular cognitive impairment.Early identification of risk factors and active measures are important for delaying the progression of dementia.However,in non-stroke populations,the relationship between vascular risk factors,extracranial and extracranial arterial lesions,and collateral circulation in the brain and VCIND remains unclear.Objective To investigate the correlation between vascular cognitive impairment no dementia(VCIND)and vascular risk factors,cerebral artery extension,cerebral artery stenosis and collateral circulation,and to further understand the mechanism of VCIND.Methods The patients who received whole cerebral angiography were enrolled in the Affiliated Zhongnan Hospital of Wuhan University from September 2010 to December 2015.According to the inclusion and exclusion criteria of VCIND and control group,312 subjects(Negative control,NC,n = 168)and VCIND group(n =144).Quantitative assessment of vascular risk factors was assessed for all subjects using the Framingham Stroke Risk Profile(FSRP)using a standardized questionnaire to collect the general condition of all subjects with reference to the relevant guidelines;complete cognitive neuropsychological scales were used to detect multiple cognitive domains including overall cognitive function,memory function,executive function,language function,and visual spatial function in all subjects;Digital subtraction angiography(DSA)was used to evaluate the cerebrovascular morphology of the subjects and whether the subjects had prolonged dilation of cerebral arteries,presence or absence of stenosis and stenosis,and establishment of collateral circulation.The statistical software SPSS 19.0 was used to analyze the data.Results1.In this study,a total of 389 non-stroke subjects were screened in this study,seventy-seven of them were excluded due to other causes of cognitive impairment or other neurological disorders.According to the inclusion and exclusion criteria of VCIND and the control group,144 people were diagnosed with VCIND,including 76 males(52.78%)and 68 females(47.22%)with a mean age of(62.85 0±6.73)years.According to the principle of age and gender matching,168 people with normal cognition were selected as the negative control group(NC group),among which 98(58.33%)were male,70 were female(41.67%),and the mean age was 59.40±4.46.2.The results of single factor analysis of variance showed that compared with NC group,VCIND group had higher FSRP score,age,higher systolic blood pressure,higher prevalence of diabetes,high incidence of cardiovascular disease,the incidence of left ventricular hypertrophy was high and the use rate of antihypertensive drugs was higher(P<0.01).Binary logic multivariate regression analysis showed that education level,alcohol and some FSRP risk factors(age,systolic blood pressure,presence of cardiovascular disease history and antihypertensive drug use history)were significantly associated with VCIND.3.Grouping according to Framingham’s stroke risk,the results showed a significant correlation between FSRP and VCIND(P<0.01),and the high-risk group is more likely to suffer from VCIND(P<0.0125).4.Compared with low-risk-FSRP group,MMSE scores were lower in middle-and high-risk groups,and TMT-B scores were higher(P<0.05),but there was no significant difference between the low-risk group and the intermediate-risk group(P>0.05),but there was no significant difference between the low-risk group and the intermediate-risk group(P>0.05).5.The MMSE scores,RAVLT scores,DSST scores,CDT scores,and VF scores in the VCIND group were significantly lower than those in the NC group(P<0.05),whereas the VCIND group had a significantly higher TMT-B score(132.59± 38.76)compared with the NC group(90.46 ± 29.93)(P<0.05).6.Compared with NC group,the VCIND group had a higher incidence of cerebral arterial extended dilatation(P = 0.010),and the incidence of VCIND was significantly correlated with the presence of cerebral arterial extended dilatation and there was no significant correlation with the type and location of warping.7.The degree of carotid stenosis was significantly correlated with VCIND(P<0.01),and the rate of VCIND in patients with severe stenosis was significantly higher than that in the non-stenosis group(P<0.0125).However,there was no significant correlation between part of carotid artery stenosis and VCIND.8.The degree of posterior circulation artery stenosis is significantly correlated with VCIND,but it was impossible to distinguish which degree of stenosis was superior in patients with VCIND.There was no significant correlation between part of posterior circulation artery stenosis and VCIND.9.The degree of carotid artery stenosis is closely related to the establishment of collateral circulation(P = 0.024),that is,there was no significant correlation between the degree of carotid stenosis and the type of collateral circulation opening.10.The incidence of VCIND was significantly lower in subjects with carotid· stenosis with collateral circulation than in those with carotid stenosis but no collateral circulation(P = 0.001).11.Patients with risk factors related-VCI were more likely to have vascular abnormalities(plaques,vascular stenosis or collateral circulation)by DSA test.However,there was no significant correlation between type of risk factors and vascular abnormalities.Conclusion Vascular risk factors,including overall burdens including dependence on drinking,increased systolic blood pressure,diabetes,history of cardiovascular disease,antihypertensive medications,and left ventricular hypertrophy,significantly increased the risk of VCIND,and the prolonged expansion of cerebral arrteries,Carotid stenosis,posterior circulation arterial stenosis,and poor cerebral collateral circulation significantly increased the risk of VCIND.The condition of cerebral arterial disease and collateral circulation can be used as a monitoring index for the onset of VCIND and should be identified and intervened early.In this study,vascular risk factors and vascular morphology were analyzed in patients with risk factor-related VCI.The occurrence of risk factor-related VCI is closely related to the abnormality of vascular morphology.Plaques,vascular stenosis,and the establishment of collateral circulation in abnormal types are potential risk factors.However,there was no significant correlation between the type of risk factors and the type of vascular morphology.Large sample data are still needed to further verify this result.