The Clinical Characteristics Of Vascular Cognitive Impairment (VCI) And The Clinical Utility Of Cerebral Vascular Reactivity On It

【Abstract】 Objective To investigate the clinical characteristics of vascular cognitive impairment (VCI) and to evaluate and compare the contribution of neuropsychological test such as Mini-Mental State Examination(MMSE) and clock-drawing task, event-related potential(ERP), cerebrovascular reserve capacity{Applying transcranialr doppler sonography (TCD) to measure vascular motor reactivity(VMR)}, single photon emission computed tomography SPECT. Methods For the study, patients conforming VCI standard admitted to our neurological department of ChangHai hospital from December,2003 to April,2004 were selected. VCI group included 20 patients and control group was same. Both groups used the Chinese Stroke Scale (CSS),Mini-Mental State Examination(MMSE) and clock-drawing task , Event-related potential(ERP) (P300,N400),VMR and SPECT. Vascular motor reactivity (VMR) was used for investigating the cerebrovascular reserve capacity and SPECT was used for investigating he region cerebral blood flow(rCBF). Result The study detected MMSE scale of VCI subjects had significant deterioration (P<0.001) in the following subtests: visuospatial skills, orientation to time and place, calculation skills, memory, executing skills and language. After patients with VCI divided into mild (27-22), moderate(21-18) according to MMSE scale, It showed significant difference (P<0.001) was detected between mild and moderate. There were no significant difference (P>0.05) in the parameter of P300 and N400. VMR and pulsate index(PI) were significantly (P<0.001) different in VCI subjects as compared with NC subjects. SPECT showed that the rCBF decrease of frontal lobe, temporal lobe was the most prominent P < 0. 01). VMR and SPECT had relationship. It showed positive relationship (P<0.05). Conclusions Patients with VCI showed general deterioration of visuospatial skills, orientation to time and place, calculation skills, memory, executing skills and language. Its main clinical features in early stage VCI were deterioration of visuospatial skills, orientation to time and place, executing skills. Finding suggested that Clock-drawing task may be useful in detecting early stage VCI. However, P300 and N400 in Event-related potential lacked sensitivity in the early stages of VCI. The study showed that Vascular motor reactivity(VMR) can be used to be a assistant tool in the diagnosis and evaluation of the early stages of VCI. It can be used to be an objective guideline suggesting the prognosis of VCI. Meanwhile SPECT of patients with VCI showed the rCBF decrease of frontal lobe, temporal lobe was the most prominent. VMR showed accordance with SPECT, so VMR can be used to reflect indirectly the situation of cerebral vascular blood flow.