An investigation of the relationship between vascular cognitive impairment and the clinical types of cerebral infarction and leukodystrophy

Abstract

Objective To assess the relationship between the location, quantity and leukodystrophy of cerebral infarction and vascular cognitive impairment (VCI), and to compare the differences of the severity and domains of cognitive impairment among the different types of cerebral infarction, which will provide the pathophysiological evidence to the mechanism for the development of VCI. Method The patients suffering from cerebral infarction or leukodystrophy were recruited from either the ward or clinic in Tianjin General Hospital from April 2009 to April 2010, then assessed the cognition, and classified into different groups according to the location, size, quantity, whether or not they have leukodystrophy and the severity. The Logistic regression analysis was taken with whether or not the patients have had developed to the VCI as the dependent variable, and with the location, size, quantity, whether or not they have leukodystrophy and the severity as the independent variables. The differences of the score of NIHSS, Bathel index and the level of cognitive impairment were compared among patients with different types of lesions. Moreover, the difference of the score of MoCA for each cognitive domain were compared among patients with different types of lesions. Results There was a relationship between key position infarction in the subcortex and white leukodystrophy with VCI. The position infarction in the subcortex and white leukodystrophy (gradeⅡand Ⅲ) might be the independent risk factors for the VCI（OR=1.752,2.135,3.753; 95%CI 1.533—3.821, 1.541—6.787, 1.432—6.821, all P<0.05）. There were significant differences in the domains of excusive ability, attention, calculation, fluent language and orientation. The average scores of the domain of excusive ability in the subcortical group (3.40±1.90) and the mix group (3.83±1.27) were significantly lower than the cortical disease group（4.28±0.89, t=0.050, 0.857, both P<0.05）. The average scores of the domains of attention, calculation, fluent and orientation in the mix group were significantly lower than the subcortical group and cortical disease group. Conclusions There is a significant association of the key infarction in the subcortex and leukodystrophy with VCI. The patients with both the subcortex infarction and leukodystrophy are susceptible to VCI. The development of VCI is depended on the position of infarction instead of the quantity and size of infarction. The development of VCI is not only related to the white matter disease but also related to the severity of the leukodystrophy. The data highlights the need to small vessel disease. The patients with subcortical lesions mainly impair the executive ability. The patients with mix lesions may have more extensive domains and more severe cognitive impairment. Key words: Cognition disorders; Brain infarction; Dementia; vascular; Cerebrovascular disorders