The Relationship Of Risk Factor,Neuropsychological And Intracranial Hemodynamics Of Subcortical Ischemic Vascular Disease

Part one: Risk Factor of Cognitive Impairment in Patients with Subcortical Ischemic Vascular DiseaseObjectives: To investigate the risk factor for cognitive impairment of SIVD.Methods: 153 patients with SIVD diagnosed according to the MRI criteria of Erkinjuntti and neuropsychological profiles were divided into vascular cognitive impairment(VCI) and no cognitive impairment(NCI) group. Registration respectively in patients with clinical data including:age,gender,education level,smoking,drinking?Presence of merge hypertension,diabetes,atrial fibrillationcoronary,heart disease.Records of laboratory biochemical indexes,triglyceride(TG),homocysteine levels numerical?Use of statistical software SPSS17.0,risk factor profiles for cognitive impairment of SIVD were compared using univariate and multivariate logistic regression analysis.Results:As to the risk factor for cognitive impairment, hypertension [OR 15.368(2.719 to 53.749)], diabetes mellitus [OR 3.501(1.108 to 9.505)],hyperlipidemia [OR 3.920(1.326 to 10.978)] and homocysteine [OR 8.016(2.183 to 38.626)] were associated with VCI patients, even in the multivariate stepwise Logistic analysis after controling for the effects of other variables? But no correlations was found between gender?smoking?alcohol drinking ?coronary artery disease?atrialfibrillation and cognitive impairment. Age?education level were associated with VCI patients.Conclusion:1. Advanced age?lower educational level could be related to SIVD?2.Hypertension?diabetes mellitus?hyperlipidemia and homocysteinemight be the main risk factors for cognitive impairment of SIVD, and the risk increase 15.368?3.501?3.920 and 8.016 times respectively? Part two : Study of cognitive impairment with subcortical ischemic vascular diseaseObjective:To analyze the cognitive profile of patients with subcortical ischemic vascular disease by using a set of cognitive measures.Methods:Extensive neuropsychological tests including MMSE and covering 5 cognitive domains were performed on 153 patients with SIVD diagnosed according to the MRI criteria of Erkinjuntti The patients were divided into Va D(n=44) ?VCIND group(n=43)and NCI group(n=66)?Results:1.The overall level of cognitive performance in these tests was significant inferior in Va D subjects as compared to normal elders( P?0.05).2.The patients with VCIND were worse than the NCI subjects in t he tests including MMSE,digit span test(DST)backwards and trail makin g test(TMT)( P?0.05).3.Compared with VCIND patients,Va D subjects showed decline on the word recall,TMT,clock drawing test and DST( P?0.05).Conclusion:1.SIVD might be related to comprehensive cognitive impairment,es pecially contributed to the deterioration of executive and attention functi on.The impairments of language and memory could be affected slightly.2.The predominant impairments in patients with VCIND could be executive and attention deficts. Part three: The correlational study between Mo CA score of subcorti cal ischemic vascular disease and intracranial hemodyn amicsObjective: To explore a practical, convenient method which can achieve early detection the cognitive disorder related SIVD.Method: 115 patients with SIVD diagnosed according to the MRI criteria of Erkinjuntti and neuropsychological profiles were divided into vascular cognitive impairment(VCI) and no cognitive impairment(NCI) group. Use transcranial doppler ultrasound(TCD) to detect intracranial hemodynamics after hospitalization. Finally, analyze the correlation between cognitive score and pulsatility index(PI) and mean velocity(Vm) of middle cerebral artery(MCA)and anterior cerebral artery(ACA).Results:1.The factors such as age ? gender ? educational level of cognitive impairment and cognitively normal group have no statistical significance by comparing the analysis(P > 0.05).2.Pulsatility index(PI) of the middle cerebral artery(MCA)and the anterior cerebral artery(ACA) in cognitive impairment group and cognitively normal group have statistically significant(P< 0.05) by the single factor analysis; There is no statistical difference about the mean velocity(Vm) of MCA and ACA(P > 0.05).3.Multiple linear regression suggests the pulsation index of middle cerebral artery have linear correlation with the cognitive impairment rela ted to SIVD,regression equation:Y=38.783-7.823X1,P<0.01,The analysis has notable statistical significance.Conclusions:1.The pulsatility index of middle cerebral artery might be linearly correlated to the cognition impairment related to SIVD,in other words,the higher the MCA-PI is, the more severe the cognitive impairment is.2.The pulsatility index increased of the MCA might be predict the cognitive impairment early.