| Objective:1.By collecting the basic information and the clinical data of 77 subcortical ischemic cerebral small vessel disease patients.Assessment it's sleep quality(PSQI,ESS,ISI),emotional state(PHQ9) and cognitive function(MMSE ?Mo CA);Acoording to Aharon-Peretz standard classified the white matter lesions to different degree. Analysis the changes about these:1 ? The difference of sleep,depression scale scores and cognitive function between small vascular disease group and health controls;2?The difference of sleep,depression and cognitive scale scores in vascular dementia group, vascular cognitive impairment with no dementia group,and cognitive function normal group;3?The correlance of sleep,depression and cognitive scale scores with cerebral white matter lesions classification.To discuss the subcortical ischemic cerebral small vessel disease patients',sleep,emotional,the cognitive function and the correlation with white matter lesions.2 ? In order to find the early biological markers of the subcortical ischemic cerebral small vessel disease cognitive dysfunction patients,We measure the peripheral blood red cell for A-beta positive rate and contentment of all the people into the group, analysied and comparison:1?The differences of peripheral blood red cell membrance of A beta positive rate between the cerebral vescular disease group and healthy controls;2?the differences of peripheral blood red cell membrance of A beta positive rate and the content in vascular dementia group, vascular cognitive impairment with no dementia group and cognitive function normal group;3?The correlation of the peripheral blood red cell membrance A beta content with white matter lesions and impaired cognitive functions.Then provide the evidence to small vascular cognitive dysfunction patients for early clinical intervention.Methods:?.Selected 96 patients who were in the General hospital of Tianjin medical university clinic or hospital from May 2015 till May 2016,chosse 77 patients whocooperated with all the test and clinical data were completed as research group.Divided the 77 people into three groups according to clinical features and cognitive function score. 32 cases of vascular dementia, 21 cases of vascular cognitive impairment with no dementia group and 24 cases of cognitive function in normal group. Chosse 90 people whose cognitive function and head of Magnetic Resonance Imaging were normal in the center of the physical examination or in hospital as Healthy Controls. Registerd the basic information and risk factors of all the research object.Evaluated cognitive functions by Mini Mental State Exam(MMSE)and Montreal Cognitive Assessment(Mo CA);Evaluated the subjective sleep quality by the Pittsburgh Sleep Quality Index(PSQI), Epworth Sleeping Scale(ESS) and Insomnia Severity Index(ISI); Evaluated depression by 9 items patient health questionnaire(PHQ9). Analysis the changes about these:1 ? The difference of cognitive,sleep and depression scale scores between small vascular disease group and health controls;2?The difference of cognitive,sleep and depression scale scores in cognitive function normal group, vascular cognitive impairment with no dementia group and vascular dementia group;3?The correlance of cerebral white matter lesions classification with cognitive and depression.?.Determinated the peripheral blood red cell membrance of A beta positive rate and the content of all the 77 cases of cerebral small vascular disease patients and 90 healthy controls patients,analysis and comparison:1 ?The differences of peripheral blood red cell membrance of A beta positive rate between the cerebral vescular disease group and healthy controls;2?the differences of peripheral blood red cell membrance of A beta positive rate and the content in cognitive function normal group, vascular cognitive impairment with no dementia group and vascular dementia group;3?The correlation of the peripheral blood red cell membrance A beta content white matter lesions and impaired cognitive functions.Results:1?CSVD patients PSQI scale score,Ess scale score higher than the HC group,the difference was statistically significant.The ISI scale score were no statistical difference between the two group.The PSQI scale scores show:CSVD group of patients with sleep disorders,daytime dysfunction scores higher than that of HCgroup,sleep lantency,sleep contimuity,sleep efficiency score below HC group,the difference was statistically significant.The sleep quality and sleep medicine score were no statistical difference. The PSQI scale score,Ess scale score were reduce in turn among VD,VCIND and NC group.The difference had statistical significance;There were no statistical significance of ISI scale score among the three groups;PSQI scale score shows:the sleep disorders,daytime dysfunction score were reduce in turn among VD,VCIND and NC group and the difference had statistical significance;The sleep latency,sleep continuity score were higher in turn among VD,VCIND and NC group and the difference had statistical significance;The sleep quality,sleep effiency,sleep medicine score were no statistical significance among the three groups.2 ? The CSVD group got higher score than HC group in depression scale PHQ9,and the difference was statistically.The PHQ9 scores was increasing through NC group,VCIND group and VD group,and the difference between groups were statistically significant.3?The score of MMSE show that,the NC group got higher scores in total and all the field than VCIND group and VD group.The VCIND group's score were higher than VD group either.The NC group,VCIND group and VD group got different scores in total scores,calculation,delayed recall and language ability,and the difference were statistically significant.According to the results between NC group and VD group,VCIND group and VD group,directional and memory scores were different.According to the results of MOCA scores, the NC group got the higher score than VCIND group and VD group in all the fields.These three groups got different scores in visual space and executive function,language,abstract and delayed recall,and the differences were statistically significant.The naming,note,directional scores were different between the NC group and VD,VCIND and VD group.4?The NC group has a more proportion of cerebral white matter lesions grade 1and grade 2 than VCIND group and VD group,the differences were statistically significant.The NC group of patients with cerebral white matter lesions 3 significantly less than the proportion of VCIND group and VD group.The proportion of NC group of white matter lesions grade 4 was lower than VD group.The proportion of patientsin white matter lesions level 3 and 4 were statistically lower in VCIND group than VD group.5?The PSQI scale,sleep disorders,daytime dysfunction score,ESS score were positively correlated with white matter lesions classification;The sleep latency,sleep sustainability score,sleep efficiency score were negative correlated with white matter lesions classification;The sleep quality score,drug score and the ISE scale score had no obvious correlation with white matter lesions classification of subcortical ischemic CSVD patients.6 ? The cerebral white matter sparse classification and PHQ9 scores were positively correlated.7?The cerebral white matter lesions classification has the negative correlance with All the cognitive areas.8 ?Compared with healthy controls,the CSVD group had a higher peripheral blood red cell membrane A beta deposition rate,and the difference was statistically significant.The NC group had less red cell membrane A beta deposition rate than VCIND group and VD group.The difference of red cell membrane A beta deposition rate between VCIND group and VD group was no statistically significant.9?Compared with white matter lesions level 3 group and white matter lesions 4group,The white matter lesions in grade 1 group had lesser peripheral blood red cell membrane A beta deposition rate,and the difference was statistical significance; The peripheral blood red cell membrane A beta deposition rate was no statistically significant difference between grade 1 group and grade 2 group,and the same as grade3 group compared with grade 4 group.10 ? The white matter lesions classification and peripheral blood red cell membrane A beta deposition were positively correlated.The peripheral blood red cell membrane A beta deposition were negative correlated with CSVD patients' MMSE,MOCA scores and the scores of all the areas.Conclusions:1?Subcortical ischemic CSVD patients had subjective sleep quality change,at the same time were easy to merge depression and cognitive dysfunction.Sleep quality chang include the incubation period shorten,sleep duration,sleep disorder,sleep in daytime,daytime function disorder,but these change had no correlation with sleep medicine;The characteristics of cognitive dysfunction were language ablity,visual space and executive function,computing power,abstract,delayed recall ability were damaged in early time,and the directional score,immediate memory and naming ability were damaged in late time.2?The subject sleep quality change and the risk of depression were more obvious in VD group than VCIND group, Sleep quality chang include the incubation period shorten,sleep duration,sleep disorder,sleep in day time,daytime function disorder,but these change had no correlation with sleep medicine;3?The VD patients given priority to cerebral white matter lesions level 4 and the VCIND patients given priority to cerebral white matter lesions level 3,the patients with normal cognitive function given priority to cerebral white matter lesion 1 and 2;The heavier the degree of cerebral white matter lesions,the subjective sleep quality chang,the depression status and cognitive disfunction were more serious. Sleep quality chang include the incubation period shorten,sleep duration,sleep disorder,sleep in day time,daytime function disorder,but these change had no correlation with sleep medicine;4?The peripheral blood red cell membrane A beta deposition rate and amount were more higher than that of healthy controls;There was a positive correlation of peripheral blood red cell membrane A beta deposition rate and amount with the degree of white matter lesions and the peripheral blood red cell membrane A beta can represent the damage degree of white matter.5 ? The peripheral blood red cell membrane A beta deposition were positive correlated with CSVD patients'.cognitive function,and the peripheral blood red cell membrane A beta can represent the damage degree of cognition.To sum up,the pathogenesis of subcortical ischemic CSVD may be associated with A beta,peripheral blood red cell membrane beta deposition amount can be used as a biological marker in subcortical ischemic CSVD disease process. |
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