Abstract
Abnormal reductions in cortical cerebral blood flow (CBF) have been identified in subcortical vascular cognitive impairment (SVCI). However, little is known about the pattern of CBF reduction in relation with the degree of cognitive impairment. CBF measured with three-dimensional (3D) Arterial Spin Labeling (ASL) perfusion magnetic resonance imaging (MRI) helps detect functional changes in subjects with SVCI. We aimed to compare CBF maps in subcortical ischemic vascular disease (SIVD) subjects with and without cognitive impairment and to detect the relationship of the regions of CBF reduction in the brain with the degree of cognitive impairment according to the z-score. A total of 53 subjects with SVCI and 23 matched SIVD subjects without cognitive impairment (controls), underwent a whole-brain 3D ASL MRI in the resting state. Regional CBF (rCBF) was compared voxel wise by using an analysis of variance design in a statistical parametric mapping program, with patient age and sex as covariates. Correlations were calculated between the rCBF value in the whole brain and the z-score in the 53 subjects with SVCI. Compared with the control subjects, SVCI group demonstrated diffuse decreased CBF in the brain. Significant positive correlations were determined in the rCBF values in the left hippocampus, left superior temporal pole gyrus, right superior frontal orbital lobe, right medial frontal orbital lobe, right middle temporal lobe, left thalamus and right insula with the z-scores in SVCI group. The noninvasively quantified resting CBF demonstrated altered CBF distributions in the SVCI brain. The deficit brain perfusions in the temporal and frontal lobe, hippocampus, thalamus and insula was related to the degree of cognitive impairment. Its relationship to cognition indicates the clinical relevance of this functional marker. Thus, our results provide further evidence for the mechanisms underlying the cognitive deficit in patients with SVCI.
Highlights
MATERIALS AND METHODSCognitive impairment after stroke is extremely common even after successful clinical recovery, a research showed the incidence of dementia after stroke is 20% at 6 months (Pendlebury and Rothwell, 2009)
subcortical ischemic vascular disease (SIVD) can be defined as subcortical white matter (WM) hyperintensity on T2-weighted imagings with at least one lacunar infarct, in accordance with the criteria suggested by Galluzzi et al (2005)
We performed a whole-brain voxel-based analyses (VBA) using the SPM8 program for the 3D Arterial Spin Labeling (ASL) magnetic resonance imaging (MRI) data, as we described in previous research (Feng et al, 2013; Kim et al, 2013)
Summary
MATERIALS AND METHODSCognitive impairment after stroke is extremely common even after successful clinical recovery, a research showed the incidence of dementia after stroke is 20% at 6 months (Pendlebury and Rothwell, 2009). Vascular cognitive impairment (VCI) describes cognitive deficits that are secondary to any type of cerebrovascular disease, including both sporadic and inherited conditions, those affecting cortical and subcortical regions and those involving large and small cerebral vessels (Román et al, 2004; Rosenberg et al, 2016). Small vessel disease (SVD), which includes lacunes in the basal ganglia and deep white matter (WM), and more diffuse lesions in the WM, often termed leukoaraiosis (Hachinski et al, 1987), is recognized as the key mechanism of VCI; this condition is named subcortical vascular cognitive impairment (SVCI), which has an important synergy with neurodegeneration (Wardlaw et al, 2013). Except for cognitive impairment, deficits in attention, execution, verbal fluency, and in particular, set-shifting performances are common in SVDs (Roh and Lee, 2014). As the world population ages, the cognitive impairment has emerged as a growing concern in public health
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