Cerebral Small Vessel Disease Group Research Articles

Laterality of Attentional Networks in Patients With Cerebral Small Vessel Disease.

Introduction: Problems with attention are common in patients with cerebral small vessel disease (CSVD). The normal human brain exhibits functional and structural asymmetry. However, it is unknown whether there is lateralization of attention in patients with CSVD.Objective: This study aims to investigate attention separately in both cerebral hemispheres in patients with CSVD using the computer-based Lateralized Attention Network Test—Revised (LANT-R).Methods: The total number of subjects included was 58, which includes the CSVD (N = 35) and healthy control (HC, N = 23) groups. All subjects completed the LANT-R paradigm and neuropsychological background tests.Results: The results indicate that there is an left hemisphere (LH) lateralization in orienting network efficiency in the HC group. However, this lateralization was not apparent in the CSVD group. Furthermore, the difference between groups was significant (interaction P = 0.02). In addition, the scores of subjects in the CSVD group are lower in several cognitive domains, including attention function, memory function, information processing speed, and executive function, compared with the controls.Conclusion: Patients with CSVD change in the lateralization of attention compared with the normal elderly. The decrease in attention in patients with CSVD might be caused by the reduced ability of selecting useful information in the LH.

Correlation of empathy with cognitive function in patients with cerebral small vessel disease

Objective To explore the empathy of patients with cerebral small vessel disease (CSVD) and its relationship with cognitive functions. Methods A total of 35 patients with CSVD and 26 normal controls with matching gender, age and education were enrolled.The Chinese version of the interpersonal reactivity index (IRI-C) and the multifaceted empathy test(MET) were used to assess the empathy of the participants.The montreal cognitive assessment scale (MoCA), the Hamilton anxiety scale(HAMA), and the Hamilton depression scale (HAMD) were applied to assess participants' overall cognitive function and emotional state.SPSS 19.0 software was used to analyze the differences between the CSVD group and the control group, while the influencing factors of empathy were studied by Pearson correlation analysis. Results The total scores of IRI, perspective taking(PT), fantasy(FS) and empathy concern(EC) of CSVD patients ((37.25±11.71), (6.94±4.35), (9.45±4.68) and (16.40±4.34)) were lower than those of the control group ((50.61±11.07), (11.84±3.90), (13.23±5.01), (19.69±3.03)), and the differences were statistically significant (IRI score: t=4.506, P 0.05). The MET-C results showed that there was a difference in the correct number of empathic emotion recognition between the two groups(CVSD group: (25.08±6.77), control group: (32.30±3.42), t=4.978, P 0.05). Pearson correlation analysis showed that the total score of IRI and PT in the CSVD group were positively correlated with education level (r=0.374, 0.471, both P<0.05). PT was positively correlated with MoCA score (r=0.458, P=0.006). PD was positively correlated with HAMA score and HAMD score (r=0.521, 0.541, both P<0.05). The correct number of emotion recognition was positively correlated with education level (r=0.600, P<0.001) and MoCA score (r=0.665, P<0.001), and negatively correlated with HAMA score(r=-0.445, P<0.05) and HAMD score (r=-0.421, P<0.05). Conclusion The empathy of patients with CSVD is lower than that of the normal group, and it is manifested as a decline in cognitive empathy, which is positively related to the overall cognitive function. Key words: Cerebral small vessel disease; Empathy; Cognitive function

Abstract TP465: Autonomic Dysfunction and Potentially Related Brain Regions in Cerebral Small Vessel Disease

Objects: To observe the fluctuations of nocturnal oxygen saturation, heart rate and blood pressure and whether there are autonomic dysfunction related brain regions in cerebral small vessel disease (CSVD). Methods: Consecutive patients with arteriosclerotic CSVD and community-dwelling elders without CSVD between 50 and 80 years old were enrolled. The parameters of oxygen saturation fluctuations and heart rate variability(HRV) were synchronously collected by polysomnography(PSG). 24-hour ambulatory blood pressure monitoring were also performed to assess the circadian rhythm and blood pressure variability(BPV). The differences in the above parameters were analyzed using appropriate statistical methods. Additionally, the voxel based morphometry (VBM) analysis was used to determine whether there were autonomic dysfunction associated structural alterations in CSVD. Results: 1. 51 patients were included in CSVD group and 37 in control group. After adjustment for gender, age, hypertension, stroke, BMI and apnea-hypopnea index(AHI), CSVD was independently associated to oxygen desaturation index (P=0.039).After adjusting age, gender, hypertension, stroke, AHI, and periodic limb movement index during sleep, significant difference of the standard deviation of normal-to-normal intervals(SDNN) during sleep period existed (P=0.030).The ratio of patients with reverse dipping patterns was higher in CSVD group after correcting age, gender, stroke, use of antihypertensive drugs, AHI and BP levels at the same periods. But no statistical differences in all BPV parameters were determined between two groups. 2. 19 CSVD patients and 16 community elders were finally included for VBM analysis. After adjustment for age, gender and AHI, grey matter atrophy in certain brain regions were more significant in CSVD group, especially in the right inferior orbitofrontal gyrus, superior medial frontal gyrus, insula, medial cingulate and bilateral medial temporal gyrus. Conclusion: CSVD patients have autonomic dysfunction which may be related with grey matter atrophy in part of autonomic network associated brain regions.

Correlation between Helicobacter pylori infection and homocysteine levels and cerebral small vessel disease

Objective To study the relationship between Helicobacter pylori (HP) infection and homocysteine (Hcy) levels and cerebral small vessel disease (CSVD). Methods From March 2017 to December 2018, 67 patients (outpatient and inpatient) who complained of dizziness in the First Affiliated Hospital of Jinzhou Medical University were divided into CSVD group(30 cases) and control group(37 cases). Single factor analysis, Spearman correlation analysis and binary logistic regression analysis were used to analyze the influencing factors of CSVD.Receiver operating characteristic curve was used to predict the diagnostic value of influencing factors for CSVD.The effects of HP and Hcy on CSVD were analyzed using mediation effect. Results (1)Hcy (r=0.345, P=0.004), HP positive (r=0.274, P=0.026), age (r=0.420, P=0.000), male (r=0.260, P=0.034), total cholesterol (r=0.273, P=0.025), triglycerides (r=0.272, P=0.026), hypertension (r=0.454, P=0.000), diabetes (r=0.284, P=0.020), smoking (r=0.499, P=0.000), coronary heart disease (r=0.284, P=0.020) were positively correlated with CSVD.(2)Logistic regression analysis showed that Hcy (β=0.315, OR=1.370, 95%CI=1.025-1.831), total cholesterol (β=0.979, OR=2.661, 95%CI=1.086-6.523) were independent risk factors for CSVD.(3)Hcy (sensitivity: 76.7%, specificity: 86.5%)and total cholesterol levels(sensitivity: 90.0%, specificity: 83.8%) had specific and sensitive diagnostic value for the diagnosis of CSVD, and total cholesterol (area under ROC curve=0.928) had more diagnostic value than Hcy (area under ROC curve=0.877). (4) The mediating effect of HP on CSVD was not completely affected by the mediating effect of Hcy, and HP had partially direct effect on CSVD. Conclusions (1) Hcy and total cholesterol are independent risk factors of CSVD, which have specific and sensitive diagnostic value for CSVD, especially for total cholesterol.(2)The mediating effect of HP on CSVD is not completely affected by the mediating variable Hcy, and HP has a partially direct effect on CSVD. Key words: Cerebral small vessel disease; Risk factors; Homocysteine; Helicobacter pylori

Serum Homocysteine as One of the Risk Factors of Cerebral Small Vessel Disease in Chinese Patients

Objective: This study aimed to determine the risk factors of cerebral small vessel disease (CSVD) from different variables including serum homocysteine (Hcy) in a group of Chinese patients. Methods: A total of 139 patients with CSVD admitted to the affiliated hospital of Xuzhou Medical University from July 2017 to July 2018 were enrolled. Fifty healthy individuals were selected as controls. According to the diagnostic criteria, the CSVD patients were divided into three groups, namely, lacunar infarction (LI) group (n=59), white matter lesion (WML) group (n=46), and LI+WML group (n=34). The serum Hcy levels of the three groups were observed and compared. Multivariate logistic regression was performed to determine whether a number of variables including serum Hcy level are the risk factors of CSVD. Results: Hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), fasting blood glucose (FBG), and Hcy were significantly higher in CSVD group than the control group (P &lt; 0.05). The age, gender, SBP, platelet, TG, and Hcy were significantly different between the LI group, WML group, and LI+WML groups (P&lt;0.05). The age and Hcy level of patients in LI+WML group were higher than those of the LI group and WML group, and the difference was statistically significant (P &lt; 0.05). The level of SBP was higher in the LI group than the WML group (P &lt; 0.05). The Hcy level of patients in the LI group was higher than that in the WML group, but there was no significant difference (P &gt; 0.05). The platelet and TG were significantly higher in WML group than LI group and LI+WML group (P &lt; 0.05). Controlling the influence of sex and age, multivariate logistic regression analysis revealed that the Hcy levels were correlated with the incidence of the CSVD. Conclusion: Serum Hcy level is a risk factor for CSVD. Regular detection of serum Hcy level and timely intervention may effectively prevent and control the occurrence and development of CSVD.

Early microalbuminuria as a clinical marker for acute cerebral small vessel infarction

ABSTRACTBackground: Previous studies have shown the potential interactions between cerebrovascular diseases and microalbuminuria. However, the relationship between urine microalbumin and acute lacunar infarction caused by cerebral small vessel disease (CSVD) remains unknown.Methods: The clinical data of 148 patients with acute lacunar infarction admitted to the Department of Neurology, Shengjing Hospital of China Medical University between April 2016 and April 2017 were analyzed. They were divided into either a CSVD group (n = 70) or a cerebral large vessel disease (CLVD) group (n = 78) according to their carotid artery B-mode ultrasonography and head magnetic resonance angiography (MRA) findings. The concentration of urinary microalbumin in both groups was determined. Statistic analysis was conducted using SAS 9.1 software (North Carolina state university, USA). A Logistic regression analysis was used to determine the independent risk factors for acute lacunar infarction caused by CSVD.Results: The concentration of urine microalbumin in the CSVD group (23 ± 12 mg/L) was significantly lower than that in the CLVD group (29 ± 15 mg/L) (p < 0. 01). However, there was an increasing trend for the proportion of patients with urine microalbumin concentration 10- < 30 mg/L (34.3%) in the CSVD group compared with the CLVD group (19.2%). Logistic regression analysis showed that microalbuminuria (10- < 30 mg/L) was independently associated with acute lacunar infarction caused by CSVD (OR = 3.582; 95% CI 1.347～6.274; p < 0.01).Conclusions: These findings demonstrate that in patients with acute lacunar infarction, slightly increased microalbuminuria seems to be a potential clinical marker for CSVD. The presence of microalbuminuria early may help to differentiate CSVD from stroke subtypes.

The consequence of cerebral small vessel disease: Linking brain atrophy to motor impairment in the elderly.

In the elderly, brain structural deficits and gait disturbances due to cerebral small vessel disease (CSVD) have been well demonstrated. The relationships among CSVD, brain atrophy, and motor impairment, however, are far from conclusive. Particularly, the effect of CSVD on subcortical nuclear atrophy, motor performance of upper extremities, and associating patterns between brain atrophy and motor impairment remains largely unknown. To address these gaps, this study recruited 770 community-dwelling subjects (35-82 years of age), including both CSVD and non-CSVD individuals. For each subject, four motor tests involving upper and lower extremities were completed. High-resolution structural MRI was applied to extract gray matter (GM) volume, white matter volume, cortical thickness, surface area, and subcortical nuclear (caudate, putamen, pallidum, and thalamus) volumes. The results showed worse motor performance of lower extremities but relatively preserved performance of upper extremities in the CSVD group. Intriguingly, there was a significant association between the worse performance of upper extremities and atrophy of whole-brain GM and pallidum in the CSVD group but not in the non-CSVD group. In addition, mediation analysis confirmed a functional CSVD-to-"brain atrophy"-to-"motor impairment" pathway, that is, a mediating role of thalamic atrophy in the CSVD effect on walking speed in the elderly, indicating that CSVD impairs walking performance through damaging the integrity of the thalamus in aging populations. These findings provide important insight into the functional consequences of CSVD and highlight the importance of evaluating upper extremities functions and exploring their brain mechanisms in CSVD populations during aging.

Association between Homocysteine and Cerebral Small Vessel Disease: A Meta-Analysis

This study aimed to evaluate whether elevated homocysteine levels is associated with risk of different subtypes of cerebral small vessel disease (CSVD) by using meta-analysis. Electronic databases were systematically searched up to April 2018 for collecting the studies reporting homocysteine levels in CSVD or CSVD subtypes. After an inclusion and exclusion criteria, the data was extracted. All data was analyzed using Stata software v.12.0 (Stata Corp LP, College Station, TX). The standardized mean difference (SMD) and 95% confidence interval (CI) were used to compare continuous variables. Eighteen studies met eligibility criteria with 5088 participants (1987 patients with CSVD and 3101 controls) included in the meta-analysis. Meta-analysis revealed that, compared with the controls group, the CSVD group had significantly higher homocysteine levels, with the SMD of .50 and 95% CI (.36-.64). Subgroup analyses suggested white matter lesion had significantly higher levels of homocysteine compared with controls (SMD = .56, 95% CI .39-.73), followed by silent brain infarction (SMD = .33, 95% CI .24-.42) and lacunar infarction (SMD = .17, 95% CI -.06 to .40). This meta-analysis found that CSVD or CSVD subtypes have a significantly higher homocysteine levels than in controls. Further prospective population-based studies are needed to longitudinally evaluate the association between homocysteine levels and progression of different CSVD subtypes.