Cognitive Function Changes And Cerebral Perfusion Mechanism In Patients With Non-disabling Ischemic Stroke Associated With Severe Stenosis Or Occlusion Of Anterior Circulation Intracranial Artery

Background:Ischemic cerebrovascular diseases have a heavy disease burden in China,often causing motor dysfunction such as hemiplegia,and often accompanied by non-motor dysfunction such as cognitive dysfunction,with a high rate of death and disability.Although the clinical symptoms of non-disabling ischemic cerebrovascular diseases are slight,the incidence is high,and the risk of recurrence and progression is high when combined with intracranial atherosclerotic stenosis,which is easy to cause cognitive impairment and seriously threatens people’s life and health.Severe stenosis or occlusion of the anterior circulation intracranial artery is an important cause of non-disabling ischemic cerebrovascular disease,and also an important risk factor of cognitive impairment.However,the current attention to cognitive function of patients with non-disabling ischemic stroke associated with severe stenosis or occlusion of the anterior circulation intracranial artery is insufficient.In addition,neuroimaging technology has made great progress in recent years,therefore,in addition to basic assessment of cognitive function,rational use of neuroimaging technology to explore the mechanism of cognitive impairment is of great significance for further understanding the disease and promoting the progress of diagnosis and treatment.Three-dimensional pseudo-continuous arterial spin labeling(3D p CASL)magnetic resonance technology can well evaluate the physiological activity of the brain and provide an effective tool for exploring the neural mechanism of cognitive impairment in patients with cerebrovascular diseases.Objective:To explore the changes of cognitive function and cerebral perfusion mechanism in patients with non-disabling ischemic stroke associated with severe stenosis or occlusion of the anterior circulation intracranial artery.Methods:A total of 47 patients with non-disabling ischemic stroke associated with severe stenosis or occlusion of the anterior circulation intracranial artery(25 in the left vascular disease group and 22 in the right vascular disease group)and 40 in the control group were included in this study.The age,sex and educational years of the groups were matched.A complete set of neuropsychological scales was used to evaluate the cognitive function of subjects,and cerebral blood flow(CBF)and spatial coefficient of variation(s Co V)were used to evaluate the perfusion of subjects.All subjects received a complete set of neuropsychological scales and magnetic resonance imaging scanning on the same day.To explore the possible mechanism of cognitive impairment by combining cognitive assessment and magnetic resonance imaging.Results:The evaluation of the neuropsychological scale showed that the scores of the Montreal Cognitive Assessment Scale(global cognitive function),the Chinese Auditory Vocabulary Learning Test(immediate,delayed,recognition,memory function),and the Semantic Vocabulary Fluency Test(fruit and vegetable,langue function)in the two patient groups were significantly lower than those in the control group(p<0.05),while the scores of the Color Trail Test A(executive function)were significantly higher than those in the control group(p<0.05).Magnetic resonance data analysis showed that the CBF value of the ipsilateral middle cerebral artery(MCA)territory was significantly decreased,while the CBF value of the contralateral region was increased.The decreased CBF value in the ipsilateral MCA territory was significantly correlated with the patient’s langue function,executive function and memory function(p<0.05),and the abnormal s Co V value in the ipsilateral MCA region was significantly correlated with the patient’s global cognitive function,langue function,executive function and memory function(p<0.05).Conclusion:The cognitive function of patients with non-disabling intracranial atherosclerotic severe stenosis or occlusion of the anterior circulation is significantly impaired,and is significantly related to abnormal cerebral perfusion.s Co V is a relatively stable and reliable indicator of the severity of cognitive impairment in patients with large intracranial artery disease.