Early Diagnosis Of Vascular Cognitive Impairment Research Articles

Cognitive impairment, dizziness, and unsteadiness in hypertensive patients

Hypertension is a widespread disease related to modifiable vascular risk factors for stroke and chronic cerebrovascular diseases. The pathogenetic basis of brain damage in hypertension is cerebral microangiopathy that leads to vascular cognitive impairment (CI), instability, and falls. Microcirculatory changes in the presence of hypertension at the initial stages of cerebrovascular disease occur without visible clinical manifestations of brain damage. Pathogenetically justified treatment used at an early stage of the disease makes it possible to achieve good results in the prevention of vascular brain damage. An important aspect of selecting effective therapy is the competent diagnosis of the causes of dizziness and instability, which can be caused not only by brain damage, but also by peripheral vestibular system diseases. Early diagnosis of vascular CI, selection of adequate therapy, and prevention of their further progression are of great importance. The studies performed have shown the high efficacy of vinpocetine (Cavinton®) that has a multifactorial mechanism of action in the treatment and prevention of CI, dizziness, and instability caused by cerebrovascular disease.

Correlations of serum cystatin C level and gene polymorphism with vascular cognitive impairment after acute cerebral infarction.

The aim of this study was to explore the possible correlations of serum cystatin C level and cystatin C gene (CST3) polymorphism with vascular cognitive impairment in patients who had acute cerebral infarction. A total of 152 patients with acute cerebral infarction were recruited in this case-control study. Patients were divided into vascular cognitive impairment (VCI) group (n = 71) and cognitive impairment no dementia (CIND) group (n = 81). The serum concentrations of cystatin C were measured with immunoturbidimetric assay while the gene polymorphisms of CST3 were determined by technique polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). In the VCI group, serum cystatin C level was significantly higher than that in the control group. The frequency of the B allele was found to be higher in the VCI group as compared with that of the CIND group (18.5% vs 7.7%, p = 0.006). In logistic regression analysis, significant associations of VCI with high serum cystatin C level (OR 3.837 (1.176-12.520), p = 0.026) and CST3 B allele (OR 2.038 (1.048-3.963), p = 0.036) were also found. A high cystatin C level and CST3 B allele confer risks for VCI after acute cerebral infarction. It is probable that measurement of the serum cystatin C level and detection of CST3 gene polymorphism would aid in the early diagnosis of VCI, but further studies are warranted.

Changes of serum cystatin C levels in patients with vascular cognitive impairment after acute stroke

Objective To explore changes and clinical significances of serum cystatin (Cys) C levels in patients with vascular cognitive impairment (VCI) after acute stroke, in order to provide evidence for early diagnosis and treatment of patients with VCI. Methods From December 2012 to December 2013, a total of 120 cases of acute stroke patients who were treated in Department of Neurology and Neurosurgery, Dongying People's Hospital were included in this study, as study group. According to whether the patients complicated VCI or not after stroke, study group were divided into VCI subgroup (n=60) and non-VCI subgroup (n=60). And at the same period, a total of 60 cases of elderly health examination who were over 50 years old and without complaints of cognitive dysfunction were included in control group (n=60). Systematic evaluations of VCI patients' cognitive function were evaluated by mini-mental state examination (MMSE) scale, and severity of VCI was divided according to results of MMSE score. Levels of serum Cys C in three group were detected with immunoturbidimetry by automatic biochemical analyzer, and relationship between serum Cys C levels and VCI severity was analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Dongying People's Hospital. Informed consent was obtained from all participants. Results There were no significant differences in gender, age, years of education, high blood pressure, diabetes and other socio-demographic data among VCI subgroup, non-VCI subgroup and control group (P>0.05). Level of serum Cys C in VCI subgroup was (1.68±0.46) mg/L, which was higher than (0.88±0.42) mg/L of non-VCI subgroup and (0.83±0.32) mg/L of control group, and difference among three group was statistically significant (F=12.99, P<0.05). In VCI subgroup, there was statistical difference of levels of serum Cys C in patients with different VCI degrees (F=7.98, P<0.05). There were 19 cases of severe VCI patients with MMSE score ≤13 whose serum levels of Cys C were (1.92±0.36) mg/L. There were 23 cases of moderate VCI patients with MMSE score of ≥14-20 whose serum levels of Cys C were (1.33±0.41) mg/L. There were 18 cases of mild VCI patients with MMSE score of ≥21-24 whose levels of Cys C were (1.09±0.28) mg/L. There was statistical difference among above three groups (F=7.98, P<0.05). The higher levels of serum Cys C in VCI patients after acute stroke were, the more serious the degree of their VCI. The results of bivariate Spearmen correlation coefficient analysis showed that there was a negative correlation between levels of Cys C and MMSE scores in VCI patients (r=-0.421, P=0.039). Conclusions Levels of Cys C in VCI patients after acute stroke were related to their development of VCI. Levels of serum Cys C could be one of biomarkers in peripheral blood as an early diagnosis of VCI, to provide biological evidence for early diagnosis and treatment of VCI. Key words: Stroke; Cognition disorders; Diagnosis; Cystatin C