Multi-modality Neuroimaging Studies Of Subcortical Infarction With Motor And Vascular Cognitive Impairmet No Dementia

Objective:We used functional MRI to investigate brain activation with hand motion in well-recovered patients and the changing on Diffusion Tensor Imagi ng with vascular cognitive impairment no dementia(VCIND) with chronic subc ortical stroke. Comparing the differences between patients and controls to test for potentially adaptive reorganization after motion system infarction and expl ore the possible methods to screen VCIND, to help promoting the rate of ide ntification and diagnosis at early stage.Methods:Collect fifty patients with subcortical stroke(the basal ganglia and/or corona radiate and brain-stem infarction) in the ward or have the risk factors of ischemic cerebrovascular disease from the clinic in Tianjin general hospita1from January2006to June2010,twenty-five without history of stroke age-m atched volunteers. Maked detailed records of the subjects basic information, in eluding: sex, age, the date of stroke, education level and medical history, etc, All the subjects who met the grouping criteria were scanned using3-Tesla bl ood oxygenation lever dependent-functional magnetic resonance imaging and di ffusion tensor imaging(DTI). All the subjects were assessed with Clinical Dem entia Rating (CDR), National Institute of Health stroke scale(NIHSS),Fugl M eyer assessment of upper limbs(FMA); Woods and Teuber of dominant hand; Mini Mental State Exam; Montreal Cognitive Assessment and Alzheimer’s Di sease Assessment Scale-cognitive subscale,ADAS-Cog) before scanning. The ha nds motion study took a block-design of left and right hand making a empty fists.24subjects with a side of subcortical the basal ganglia and/or corona ra diate and stroke met the grouping criteria of hands motion trial,3cases were removes for3D translational motion more than2mm, the translation of the3d spin more than2°,at last,21cases of the stroke data entered into the st atistical analysis,24normal volunteers for the control group.In the trial of va scular cognitive impairment,8patients did not complete assessment scale, ace ording to the above exclusion standard of image,10cases were remove,finally,13cases of Vascular Cognitive Impairment No Dementia (VCIND)with stroke, 15cases of contrals with stroke,7cases of imaging data were removed of volunteers,9cases of Vascular Cognitive Impairment No Dementia (VCIND) without stroke,9normal contrals Into the statistics analysis.The data were anal yzed with Statistical Parametric Mapping (SPM8)Results:hands movement BOLD neuroimaging studies for subcortical stroke1. In stroke patients, the affected hand motion activated the ipsilesional sens orimotor cortex(SMC), contralesional cerebellum, and bilateral supplemen tary motor areas(SMA).2. In stroke patients, the unaffected hand motion active the contralesional se nsorimotor cortex(SMC), supplementary motor areas(SMA), and ipsilesion al cerebellum.3. Controls showed expected activation in the contralateral sensorimotor cortex (SMC), supplementary motor areas (SMA), and ipsilateral cerebellum, in line with the previous studies.4. Group comparison revealed that stroke patients with affected hand motion showed greater activation in the ipsilesional Ml than control subjects.cluster size are95voxels,t-Values=4.3, the max Montreal Neurological Institute(MNI) is X=39,Y=-12,Z=60.There is no statistical difference between stroke patients with unaffected hand motion and contrals.vascular cognitive impairment of dementia DTI neuroimaging studies for subcortical VCIND1. Compaired with the other two groups, impairment scores of VCIND in the excusive ablity and delayed memory had statistical significance. Besides, there was difference in statistics in the domain of attention, calculation, fluent of the language and orientation, immediate memory between VCIND and normal cognition with stroke subjects.2. Compared with the DTI data of normal cognition with stroke subjects decreased FA in frontal-med-orb-R for VCIND subjects with stroke,the cluster size is193voxels,t-Values=4.61, the max Montreal Neurological Institute(MNI) is X=12, Y=38, Z=-6,and increased DR in the frontal-orb-R, the cluster size is73voxels, t-Values=6.48, the max Montreal Neurological Institute(MNI) is X=56, Y=32, Z=-4(corrected by AlphaSim, cluster size>64, P<0.005)3. Compared with the DTI data of normal contrals, decreased FA of VCIND with stroke in bilateral parahippocampal gyrus, left prefrontal cortex,Temp oral-Mid-L,Frontal-Inf-R, insula,occipital-L,right calcarine,right cuneus,and f rontal-inf-oper-R,and increased DR in the left insula,frontal-mid-L and pe riventricle white matter.4. Compared with the DTI data of normal contrals,decreased FA in frontal-in f-oper-R of VCIND subjects without stroke,the cluster size is120voxels,t-Values=6.42, the max Montreal Neurological Institute(MNI) is X=46, Y=12, Z=28,and right calcarine, he cluster size is73voxels,t-Values=6., the max Montreal Neurological Institute(MNI) is X=6, Y=-72,Z=12(corrected b y AlphaSim, cluster size>64, P<0.005),There is not statistically signifi cantConclusions:1. There were no significant differences in activate brain regions, draw a co nclusion that in chronic subcortical stroke, patients with good or complete recovery showed activation patterns similar to that of healthy control sub jects, Further indirectly confirmed from metabolism level that after half of year or longer from stroke, motor function of patients with unilateral sub cortical infarction can reach normal levels by neuronal plasticity.This prov ides neural imaging basis for clinical motor function rehabilitation therapy2. Good recovery was associated with relatively contralateral brain activation, and greater activation in the ipsilesional Ml (precentral gyrus), from ne ural imaging aspect, it indicates that enhance of neurons activities in patie nts with subcortical stroke in M1area may play an important role in rec overy of motor function.3. For subcortical vascular cognitive impairment no dementia, executive abilit y and delayed memory are significantly damaged, the other fields, for inst ance, immediate memory, attention, calculation, fluent of the language and orientation also damaged. 4. Compared with the DTI data of normal cognition with stroke subjects,decr eased FA in prefrontal for VCIND subjects with stroke further demonstrat es that cognitive impairment of VCIND may relate to the damage of fron tal-subcortical circuits.5. Compared with the DTI data of normal contrals, decreased FA of VCIND with stroke in hippocampal formation, frontal lobe,temporal lobe,occipital lobe,and insula,this indicates that post-stroke cognitive impairment may not only relate to white matter hyperintensity (WMH),but also to some ot hers factors,so the study provides some clude for further study of the mul ti-mechanism of post-stroke cognitive impairment6. Compared with the DTI data of normal contrals,decreased FA in frontal lobe and occipital lobe of VCIND subjects without stroke but with risk f actors, this indicates that VCIND with risk factors for stroke may not onl y relate to microstructural damage of frontal-subcortical circuits(e.g. Cell1oss or damage of white matter integrity), but also to the damage of occip ital lobe,so the study provides some base for further study of VCIND wit h risk factoes7. VCIND is the earlier stage of vascular cognitive impairment, deffusion te nsor imaging can detect the decrease of FA in special area at the VCIND stage, and it suggests that DTI can detect microstructural damage of brai n from cellular level at the earlier stage, It suggests that the DTI technol ogy may can be used as a good methods for early detection of vascular cognitive impairment.