The Analysis And Clinical Study About Vascular Cognitive Impairment With Related Factors, ERP And Regional Cerebral Blood Perfusion

Objective:To investigate the incidence of vascular cognitive impairment, the performance and the related factors which impact the severity of VCI through the registration of the patients'information. We also compared each subtypes of VCI and explored the changes of the electrophysiology and perfusion in the regional cerebral blood flow(rCBF) in the early stage of the VCI.This will facilitate the diagnosis and therapy as earlier as possible.Methods:Collect the patients who have the acute ischemic stroke(within 14±2 days) in the ward or has the risk factors of ischemic cerebrovascular disease from the clinic in Tianjin general hospital from April 2009 till April 2010. All the patients have been detected the blood pressure and completed some related chemical and image examinations. We evaluated the cognitive function by MMSE, MoCA and CDR. We also recorded their ESRS, score of Hachinski and the score of ADL. Part of the patients received the examination of ERP while some of them received the examination of cerebral blood perfusion by SPECT. We divided all the patients into 3 groups by the severity of cognitive impairment. These 3 groups are the control group(no complain of cognitive impairment), the VCIND group(CDR=0.5,ADL=20) and the VaD group(CDR≥1,ADL>20). We compared and analyzed the incidence of the VCI,the related factors and the performance of each subtypes. We compared and analyzed the incubation period and wave of the P300 and the rCBF of these important regions.Results:1 The incidence of the VCI in our study is 58.79%,of which the incidence of VCIND is 43.41%, the incidence of the mild VaD is 13.19% and the incidence of the severe VaD is 2.2%. The incidence of VaD of the patients who had the history of ischemic stroke longer than 3months is higher than the The incidence of the patients who have the acute ischemic stroke.However, there is no difference in the statistics(P>0.05).2 The incidence of the VCIND and VaD of the female is higher the male's. There is no difference in statistics in the incidence of the VCI between different gender(P>0.05). 3 The average age of the VaD and VCIND is older than the control group. There is difference in statistics in the age among these 3 groups(P<0.05). The average age of the VaD is older than the group VCIND, but there is no difference in statistics in the age between these 2 groups(P>0.05).4 The average education yeas of the VaD and VCIND is shorter than the control group. There is difference in statistics in the education yeas among these 3 groups(P<0.01). The average education yeas of the VaD are shorter than the group VCIND, and there is difference in statistics in the average education yeas between any 2 groups(P<0.01).5 There is no difference in statistics in the BMI index among the control group, the VCIND group and the VaD group(P>0.05).6 The rate of the VCIND and VaD complicated with hypercholesteremia, hyperhomocytinemia and history of ischemic stroke is higher than the control group. There is difference in statistics in the ratio of hypercholesteremia, hyperhomocytinemia and history of ischemic stroke(P<0.01).While there is no difference in statistic in the ration of other risk factors(P>0.05).7 Through the Logistic analysis, we detected that hyperhomocytinemia and education yeas are related to the development of VCI. We consider that the hyperhomocytinemia is the isolated risk factor of VCI (OR<1)while the education years is the isolated protected factor of VCI(OR>1).8 The incidence of the VCIND and VaD in the high risk group of ESSEN is higher than the low risk group, there is difference in the statistics between these 2 groups(P<0.01).The average ESSEN score of the VaD and VCIND is higher than the control group. There is difference in statistics in the ESSEN score among these 3 groups(P<0.01).9 Among the subtypes of the OCSP, the incidence of VCI and the VaD has the higher tendency in the PACI while the incidence of VCIND has the higher tendency in the POCI, but there is no difference in statistics in the incidence of VCI among these subtypes(P>0.05).10 In the stage of acute ischemic storke, the average score of NIHSS of the VCIND and VaD group is higher than the control group, but there is no difference in statistics(P>0.05).In the stage of the ischemic storke history longer than 3 months, the average score of Bathel of the VCIND and VaD group is lower than the control group, there is difference in statistics(P<0.01).The average score of Bathel of the VaD is lower than the VCIND, there is difference in statistics(P<0.01).but there is no difference in statistics between the VCIND and the control group(P>0.05).11 There is a relationship beween key position infarction in the subcortex and white matter disease with VCI(P<0.05).The position infarction in the subcortex and white matter disease may be the isolated risk factor of the VCI.12 There is difference in statistics in the incidence of VCI among different subtypes of whiter disease(P<0.01) and there is difference in statistics in the comparision of the average score of MoCA(P<0.01). There is also difference in statistics in the comparision of the average score of MoCA within any 2 groups except the group of none white matter disease vs the group of mild white disease(P<0.01).13 There is no difference in statistics in the incidence of VCI between the group of multiple infarctions and islolated infarction, although the incidence of VCI in the group of multiple infarctions is higher(P>0.05).The average score of ASPECT in the multiple infarctions is lower than the islolated infarction, but there is no difference in statistics(P>0.05).14 The incidence of the VCI in the large artery stenosis group is higher the none large artery stenosis group, but there is no difference in statistics(P>0.05).15 There is difference in statistics in the domain of excusive ablity, attention, calculation, fluent of the language and orientation(P<0.05). The average scores in the subcortical group and the mix group are lower than the cortical disease group and there is difference in statistics within any 2 groups(P<0.05).There is difference in statistic in the score of each cognitive domain among the groups of the control, VCIND and VaD(P<0.01). There is difference in statistics in the score of the each domain except the domain of fluent of the language and the calculation between the group VCIND and the control group(P<0.01).There is difference in statistics in the score of the each domain between the group VCIND and VaD(P<0.01).16 There is positive relationship between the socre of MMSE and MoCA through the analysis of Spearman. There is difference in statistics in the the socre of MoCA between the VCIND group and the control group(P<0.01) while there is no difference in statistics in the socre of MMSE between the same 2 groups(P>0.05).17 The average incubation period of the VaD and VCIND is longer than the control group. There is difference in statistics in the average incubation among these 3 groups(P<0.01). The average wave of the VaD and VCIND is higher than the control group. There is no difference in statistics in the wave among these 3 groups(P>0.05). The incubation of P300 has inverse collection with the score of MoCA through the spearman analysis(rs=-0.865,P<0.01). The incubation of P300 has inverse collection with the domain of attention, calculation and orientation (rs<0,P<0.05).18 The rCBF of the left temporal lobe, thalamus and hippocampus of VaD and VCIND is lower than the control group. There is difference in statistics in the average incubation among these 3 groups(P<0.01). The rCBF of the left temporal lobe, thalamus and hippocampus has positive collection with the score of MoCA through the spearman analysis(rs=0.581,0.490,0.487). The incidence of the low rCBF in the patients who has the stenosis of internal carotid artery or common carotid artery is higher than the patients who had no stenosis of internal carotid artery or common carotid artery, but there is no difference in statistics. The rCBF of the left temporal lobe has the positive relationship in the domain of calculation(Beta=0.445, P<0.05), and The rCBF of the right temporal lobe and hippocampus have the positive relationship in the domain of orientation(Beta=0.626,0.740,P<0.05).Conclusion:1 The incidence of the VCI in our study is 58.79%.In the composition of the VCI, VCIND takes the major part. The patients who have the history of ischemic stroke longer than 3 months have higher tendency to develop to VCI, and is more severe than the acute ischemic stroke. The female has the tendency of higher incidence of VCI. The development of VCI has the symptom of older age and fewer education years.Through the Logistic analysis, we detected that education yeas are related to the development of VCI. We consider that education years are the isolated protected factor of VCI.2 The rate of the VCIND and VaD complicated with hypercholesteremia, hyperhomocytinemia and history of ischemic stroke is significantly higher.We consider that the hyperhomocytinemia is isolated the risk factors of VCI.The ESRS is related the severity of VCI. The higher ESRS, the higher risk of stroke and the more severe of VCI is. The risk factors are more, the incidence of VCIND and VaD are more. As the result, we should pay more attention to risk factor and adopt some diplomacy.3 Among the subtypes of OCSP, the POCI heve the higher tendency in incidence of VCIND while the PACI have the higher tendency in the incidence of VaD.LACI takes the major part in the acute ischemic stroke.The disease of small vessal disease may has the significant cognitive impairment in the condition of the neurol defect is mild.4 In the stage of acute ischemic stroke, the cognitive impairment is significant when the neurol defect is mild. In the stage of ischemic stroke longer than 3 months, the cognitive impairment is less severe if the recovery of the neurol defect is better.Compare to neurol defict, the cognitive impairment seems to be more significantly and performs ealier.5 The development of VCI is depended on the position of infarction but not on the quantity of infarction.6 The development of VCI is not only related to the white matter disease but also related to severity of the white matter disease. The large artery stenosis seems has no relationship with the development of VCI which can be explained by the theory of collateral circulation compensation.We should pay attention to small vessal disease.7 The subcortical disease has the symptom of poor performance in the executive ability. The mix subtype may have more extensive cognitive domains impairment and more severe. The performance of VCIND and VaD is similar. But the impaired domains are more in the VaD and are more severe.8 Compare to MMSE, MoCA is more sensitive in the early stage of VCI.9 The more severe in the cognitive impairment the longer in the incubation period of P300. The ERP could seem to be an sensitive index of electrophysiology and could be assist measurement of the diagnosis of VCI.10 Perhaps there already has been low rCBF in the temporal lobe, thalamus and hippocampus before the obvious performance of VCI.The low rCBF in the temporal lobe, thalamus and hippocampus supply the evidence to the conclusion that the performance in pathology of VCI is low perfusion of the temporal lobe, thalamus and hippocampus.There seems to be no relationship between the stenosis of internal carotid artery or common carotid artery and the incidence of low rCBF.The SPECT could be sensitive measurement in the detection in early stage.11 We should indentify and prvent VCI in the ealy stage especially for the patients who have the vascular risk factors.We should pay more attention on the none body function impaiement and prvent the development of dementia.