Study On Risk Factors Of Cerebral Microbleeds In Patients With Ischemic Stroke And Its Relationship With Congnition

Objective:To explore the prevalence rate and the risk factors of CMBs in patients with acute ischemic stroke.The memory function, visuospatial function, executive function, language function and other cognitive function are preliminarily studied in patients with acute ischemic stroke that consolidated or unconsolidated CMBs, so as to further explore the correlation between acute ischemic stroke and cognitive function in patients with CMBs and provide quantitative parameter and basis for the future clinical diagnosis, rehabilitation and prognosis.Methods:(1) 136 patients with acute ischemic stroke who were hospitalized in the neurology department of the First Affiliated Hospital of Kunming Medical University from September 2014 to December 2015 were successionally recruited. According to whether there was CMBs, patients were divided into two groups, CMBs group (52 cases) and non-CMBs group (84 cases).Then recorded the number and distribution of CMBs in CMBs group, and compared the risk factors of the two groups, including clinical data, laboratory data and imaging data,such as gender, age, hypertension, diabetes, heart disease, smoking history, drinking history, history of stroke, hyperlipemia, use of antiplatelet drugs, fasting blood glucose, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, and the number of lacunar infarction and white matter changes severity. Risk factors of CMBs in patients with ischemic stroke were evaluated by single factor analysis and multiple logistic regression analysis and the rate and distribution of CMBs were calculated. The parameters were statistical analyzed with SPSS 19.0 software.(2) We excluded 63 patients that had the following cultural level of primary school, conscious disturbance, severe language impairment, physical movement disorders and visuospatial dysfunction, auditory dysfunction, serious somatic diseases.unstable condition, mental disorders and other states that could’t finish the test from the 136 patients of method 1.30 cases of CMBs positive group (case group), 43 cases of CMBs negative group (control group) were included at the final. The difference between the two groups in gender, age, education level and NIHSS scores were no statistical significance (P> 0.05). The two groups of patients could complete all tests of cognitive function after onset in a stable condition within 2 weeks. The Montreal Cognitive Assessment (MOCA) was used for the general assessment of the cognition. The Digital Span Test (DST) was used to assess the memory function. The Trail Making Test (TMT) and the Symbol-Digital Mode Test (SDMT) were used to evaluate the patients with visuospatial impairment. The Wisconsin Card Test (WCST) and Word Fluency Test (WFT) were used to evaluate the executive function. The Chinese Aphasia Examination Scale (CAES) was used to evaluate the language function. The Hamilton depression rating table (HAMD) was used to evaluate emotion. And the parameters were statistical analyzed with SPSS 19.0 software.Results:(1) 136 cases of the patients with acute ischemic stroke were included in our study. According to the presence of CMBs, patients were divided into 2 groups, the CMBs group of 52 people (38.24%), and the non CMBs group of 84 people (61.76%). CMBs distributed in different brain regions of patients with acute ischemic stroke, the most common region was the basal ganglia. The proportion of hypertension, previous stroke and the use of antiplatelet agents in the CMBs group was higher than the non CMBs group, the X2 test showed significant difference (P< 0.05).The index of the highest systolic blood pressure of CMBs group was higher than that of the non CMBs group. The age of CMBs group was older than that of the non group CMBs. The numbers of lacunar infarction and cerebral white matter change scores were higher than those of the non CMBs group. The t test of the index of the highest systolic blood pressure, age, the numbers of lacunar infarction and the cerebral white matter change scores showed significant difference (P< 0.05). Introducing the single factor analysis of meaningful variables into the multivariable Logistic regression model, showed that the risk factors of CMBs in patients with acute ischemic stroke were cerebral white matter changes (OR=3.088,95%CI:1.696-5.622, P=0.000), the highest index systolic blood pressure (OR= 1.062,95%CI:1.030-1.094, P=0.000) and the lacunar infarction (OR=1.739,95%CI:1.027-1.078, P=0.041).(2) CMBs positive group (case group) and CMBs negative group (control group) had no significant difference in gender, age, education and NIHSS scores. MOCA scores of CMBs positive group were significantly lower than those of the control group, the difference was statistically significant (P< 0.01). Spearman rank correlation analysis showed that, the more numbers of CMBs, the higher levels, the lower scores of MOCA, and the heavier degrees of cognitive impairment. The scores of CMBs positive group and CMBs negative group in the visuospatial function and the executive function were significantly different, the scores in the CMBs positive group were significantly lower than those of the CMBs negative group (P< 0.05).The scores in the evaluation of the memory function and the language function had no significant difference (P> 0.05), CMBs positive group depression scores were higher than that of the CMBs negative group, the difference was statistically significant (P< 0.05).Conclusion:(1) CMBs has a higher incidence in patients with acute ischemic stroke. The highest systolic blood pressure index, the lacunar infarction and the degree of white matter changes are the risk factors for CMBs.(2) CMBs occur mostly in the basal ganglia region in the patients with acute ischemic stroke.(3) CMBs and their numbers are closely associated with cognitive impairment. The more the CMBs numbers are, the more obvious the cognitive impairment will be.(4) Visuospatial and executive function decline significantly in the ischemic stroke patients with CMBs.(5) CMBs is associated with post stroke depression.