Vascular Cognitive Impairment In Patients Research Articles

Impact of COVID-19 on mild vascular cognitive impairment in patients with atrial fibrillation: results of a three-year observational study

Impact of COVID-19 on mild vascular cognitive impairment in patients with atrial fibrillation: results of a three-year observational study

Efficacy and safety of Ferrous iron on the prevention of Vascular cOgnitive impaiRment among patients with cerebral Infarction/TIA (FAVORITE): rationale and design of a multicentre randomised trial

BackgroundThe incidence of vascular cognitive impairment (VCI) is high in patients suffering from ischaemic stroke or transient ischaemic attack (TIA) or with vascular risk factors. Effective prevention strategies for VCI...

A Nomogram Including Total Cerebral Small Vessel Disease Burden Score for Predicting Mild Vascular Cognitive Impairment in Patients with Type 2 Diabetes Mellitus.

Total cerebral small vessel disease (CSVD) burden score is an important predictor of vascular cognitive impairment (VCI). However, few predictive models of VCI in type 2 diabetes mellitus (T2DM) patients have included the total CSVD burden score, especially in the early stage of VCI. To develop and validate a nomogram that includes the total CSVD burden score to predict mild VCI in patients with T2DM. A total of 322 eligible participants with T2DM who were divided into mild and normal cognitive groups were enrolled in this retrospective study. Demographic data, laboratory data and imaging markers of CSVD were collected. The total CSVD burden score was calculated by combining the different CSVD markers. Step-backward multivariable logistic regression analysis with the Akaike information criterion was applied to select significant predictors and develop a best-fit predictive nomogram. The performance of the nomogram was assessed in terms of discriminative ability, calibrated ability, and clinical usefulness. The nomogram model consisted of five variables: age, education, hemoglobin A1c level, serum homocysteine level, and total CSVD burden score. A nomogram with these variables showed good discriminative ability (area under the receiver operating characteristic curve was 0.801 in internal verification). In addition, the Hosmer-Lemeshow test (χ2 =9.226, P=0.417) and bootstrap-corrected calibration plot indicated that the nomogram had good calibration. The Brier score of the predictive model was 0.178. Decision curve analysis demonstrated that when the threshold probability ranged between 16% and 98%, the use of the nomogram to predict mild VCI in patients with T2DM provide a greater net benefit. The nomogram, composed of age, education, stroke, HbA1c level, Hcy level, and total CSVD burden score, had good predictive accuracy and may provide clinicians with a practical tool for predicting the risk of mild VCI in T2DM patients.

Association Between VISTA and Vascular Cognitive Impairment in Older Chinese Adults: A Cross-Sectional Study.

Vascular cognitive impairment(VCI) ranks as the second most prevalent type of dementia.Increasing evidence has shown that inflammation and multi-faceted neuro-immune interactions integrate systemic and central inflammatory pathways, thereby inducing vascular tissue injury and contributing to the development of vascular cognitive impairment (VCI).V-type immunoglobulin-like suppressor of T cell activation (VISTA) is an Negative checkpoint regulators(NCR) that is associated with CNS homeostasis, interactions with peripheral immunity and CNS inflammation.The primary objective of this study was to seek the correlation between VISTA and VCI in patients with cardiovascular risk factors.Our secondary objective was to explore the potential of VISTA as a biomarker for VCI. We enrolled individuals with cardiovascular risk factors in this cross-sectional study research and categorized them into two groups: without cognitive impairment (control) and with cognitive impairment (VCI). VISTA expression in peripheral blood mononuclear cells (PBMCs) was analyzed using relative quantitative polymerase chain reaction. VISTA expression was identified in monocyte subsets using flow cytometry. We use Enzyme linked immunosorbent assay to detect inflammatory factors in serum. In PBMC in patients with VCI, the expression of VSIR was significantly reduced. In contrast to controls, fasting glucose, fibrosis, and the levels of interleukin 6 (IL-6) in VCI patients were noticeably higher, and uric acid levels were significantly lower. Vsir mRNA expression in PBMCs correlated negatively with IL-6 levels, Trail Making Test B scores, and Hachinski scores and positively with Boston Naming Test scores. In intermediate monocytes, flow cytometry showed reduced Vsir expression, which was connected with VCI. The percentage of intermediate monocytes, uric acid, and the VISTA mean fluorescence intensity on intermediate monocytes were shown to be independent factors to VCI by multivariate logistic regression analysis. Decreased VISTA promotes the occurrence of VCI in patients with cardiovascular risk factors by promoting monocytes toward the proinflammatory intermediate monocyte subset. VISTA may serve as a potential biomarker for distinguishing VCI in individuals with cardiovascular risk factors.

18F-FDG PET and a classifier algorithm reveal a characteristic glucose metabolic pattern in adult patients with moyamoya disease and vascular cognitive impairment.

Vascular cognitive impairment (VCI) is a critical issue in moyamoya disease (MMD). However, the glucose metabolic pattern in these patients is still unknown. This study aimed to identify the metabolic signature of cognitive impairment in patients with MMD using 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG PET) and establish a classifier to identify VCI in patients with MMD. One hundred fifty-two patients with MMD who underwent brain 18F-FDG PET scans before surgery were enrolled and classified into nonvascular cognitive impairment (non-VCI, n = 52) and vascular cognitive impairment (VCI, n = 100) groups according to neuropsychological test results. Additionally, thirty-three health controls (HCs) were also enrolled. Compared to HCs, patients in the VCI group exhibited extensive hypometabolism in the bilateral frontal and cingulate regions and hypermetabolism in the bilateral cerebellum, while patients in the non-VCI group showed hypermetabolism only in the cerebellum and slight hypometabolism in the frontal and temporal regions. In addition, we found that the patients in the VCI group showed hypometabolism mainly in the left basal ganglia compared to those in the non-VCI group. The sparse representation-based classifier algorithm taking the SUVr of 116 Anatomical Automatic Labeling (AAL) areas as features distinguished patients in the VCI and non-VCI groups with an accuracy of 82.4%. This study demonstrated a characteristic metabolic pattern that can distinguish patients with MMD without VCI from those with VCI, namely, hypometabolic lesions in the left hemisphere played a more important role in cognitive decline in patients with MMD.

Correlations among peripheral blood markers, white matter hyperintensity, and cognitive function in patients with non-disabling ischemic cerebrovascular events.

Both inflammation and cerebral white matter injury are closely associated with vascular cognitive impairment (VCI). The aim of this study was to analyze the correlation between peripheral serological markers, white matter injury, and cognitive function in patients with non-disabling ischemic cerebrovascular events (NICE); to identify potential biological markers for the diagnosis and prediction of VCI; and to provide a basis for the early diagnosis and intervention of VCI. We collected clinical data, along with demographic and medical history data, from 151 NICE patients. Fasting venous blood samples were collected. Based on the Montreal Cognitive Assessment (MoCA) after admission, we divided the patients into normal cognitive function (NCF) and VCI groups, and then classified them into mild white matter hyperintensity (mWMH) and severe white matter hyperintensity (sWMH) based on Fazekas scores. The differences in serological marker levels were compared between the cognitive function groups and the white matter hyperintensity groups. Binary logistic regression models and receiver operating characteristic curves were used to analyze the diagnostic predictive value of serological markers for VCI in patients with NICE and in the white matter hyperintensity subgroups. Among 151 patients with NICE, 95 were male and 56 were female. Lymphocyte count (OR = 0.405, p = 0.010, 95% CI [0.201, 0.806]), red blood cell count (OR = 0.433, p = 0.010, 95% CI [0.228, 0.821]), and hemoglobin level (OR = 0.979, p = 0.046, 95% CI [0.958, 0.999]) were protective factors for cognitive function in patients with NICE. The sWMH group had a higher age, granulocyte/lymphoid ratio (NLR), and neutrophil percentage but a lower MoCA score, hemoglobin level, and lymphocyte count than the mWMH group. In the mWMH group, lymphocyte count (AUC = 0.713, p = 0.003, 95% CI [0.593, 0.833]) had an acceptable predictive value for the diagnosis of VCI, whereas white blood cell count (AUC = 0.672, p = 0.011, 95% CI [0.545, 0.799]), red blood cell count (AUC = 0.665, p = 0.014, 95% CI [0.545, 0.784]), and hemoglobin level (AUC = 0.634, p = 0.047, 95% CI [0.502, 0.765]) had marginal predictive value for the diagnosis of VCI. In the sWMH group, no significant differences were found in serological markers between the NCF and VCI groups. Lymphocyte count, red blood cell count, and hemoglobin level were independent protective factors for cognitive function in patients with NICE; they can be used as potential biological markers to distinguish VCI in patients with NICE and are applicable to subgroups of patients with mWMH.

Prevalence and Predictors of Vascular Cognitive Impairment in Patients With CADASIL.

Background and ObjectivesCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common monogenic form of stroke and early-onset dementia. We determined the prevalence of vascular cognitive impairment (VCI) in a group of patients with CADASIL and investigated which factors were associated with VCI risk, including clinical, genetic, and MRI parameters.MethodsCognition was assessed in patients with genetically confirmed CADASIL (n = 176) and healthy controls (n = 265) (mean [SD] age 50.95 [11.35] vs 52.37 [7.93] years) using the Brief Memory and Executive Test (BMET) and the Montreal Cognitive Assessment (MoCA). VCI was defined according to previously validated cutoffs. We determined the prevalence of VCI and its associations with clinical risk factors, mutation location (epidermal growth factor–like repeats [EGFr] 1–6 vs EGFr 7–34), and MRI markers of small vessel disease.ResultsVCI was more common in patients with CADASIL than in controls; 39.8 vs 10.2% on the BMET and 47.7% vs 19.6% on the MOCA. Patients with CADASIL had worse performance across all cognitive domains. A history of stroke was associated with VCI on the BMET (OR 2.12, 95% CI [1.05, 4.27] p = 0.04) and MoCA (OR 2.55 [1.21, 5.41] p = 0.01), after controlling for age and sex. There was no association of VCI with mutation site. Lacune count was the only MRI parameter independently associated with VCI on the BMET (OR: 1.63, 95% CI [1.10, 2.41], p = 0.014), after controlling for other MRI parameters. These associations persisted after controlling for education in the sensitivity analyses.DiscussionVCI is present in almost half of the patients with CADASIL with a mean age of 50 years. Stroke and lacune count on MRI were both independent predictors of VCI on the BMET.

Diagnostic Values of Serum Levels of Homocysteine, Heat Shock Protein 70 and High-Sensitivity C-Reactive Protein for Predicting Vascular Cognitive Impairment.

IntroductionVascular cognitive impairment is one of the main clinical manifestations of cerebral small vessel disease (CSVD). Reliable molecular markers are needed urgently to predict cognitive impairments in CSVD patients. This study aimed to investigate the possible diagnostic values of serum levels of Hcy, Hsp70 and hs-CRP for predicting vascular cognitive impairment in patients with CSVD.MethodsAccording to the presence of CSVD and cognitive impairment (CI), healthy patients and CSVD patients were divided into three groups. Serum Hcy, HSP70 and hs-CRP were abnormal in the CI group. Clinical characteristics and MOCA cognitive function score statistics were performed for the three groups: the control group, CSVD without cognitive impairment group and CSVD with cognitive impairment group. Finally, Hcy, HSP70 and hs-CRP were correlated with MOCA to analyze the correlation between serum Hcy, HSP70 and hs-CRP and cognitive dysfunction caused by CSVD.ResultsThe levels of serum Hcy, Hsp70, and hsCRP had significantly higher expression in the CSVD groups than those in the control group (p<0.05). Moreover, basic clinical characteristics, cardiovascular risk factors and other clinical details had no significantly differences among the three groups. Serum Hcy, Hsp70 and hs-CRP levels were negatively correlated with MoCA total scores.ConclusionSerum levels of Hcy, HSP70 and hs-CRP were negatively correlated with cognitive impairment caused by CSVD, which could be used as a predictor to predict the risk of cognitive impairment caused by CSVD.

Erythrocytes Are an Independent Protective Factor for Vascular Cognitive Impairment in Patients With Severe White Matter Hyperintensities.

Background and Purpose: Hemoglobin is one of the main proteins in erythrocytes. There are significant correlations between low hemoglobin and white matter hyperintensities (WMH) and cognitive impairment. This study explored whether erythrocytopenia has predictive value for vascular cognitive impairment (VCI) in patients with WMH.Method: We conducted a cross-sectional study of 302 patients, including 62 with cerebral small vessel disease and 240 with stroke. Basic demographic data and fasting blood were collected. First, all patients were divided into normal cognition (NC), mild VCI (mVCI), and severe VCI (sVCI) groups (subgroups later) based on cognitive behavior scores. Second, all patients were divided into mild WMH (mWMH) and severe WMH (sWMH) groups based on Fazekas scores. The differences in blood markers between different groups or subgroups with different cognitive levels were analyzed by univariate analysis. Then, binary logistic regression was used to analyze the diagnostic value of erythrocyte counts for VCI in the sWMH group, and ordinal logistic regression was used to analyze the predictive value of multiple variables for different cognitive levels.Results: Univariate analysis showed that erythrocytes, hemoglobin, high-sensitivity C-reactive protein, retinol binding protein and prealbumin were potential blood markers for different cognitive levels in sWMH patients. Among them, erythrocytopenia has good predictive value for the diagnosis of mVCI (AUC = 0.685, P = 0.008) or sVCI (AUC = 0.699, P = 0.003) in patients with sWMH. Multivariate joint analysis showed that erythrocytes were an independent protective factor reducing the occurrence of VCI in patients with sWMH (OR = 0.633, P = 0.045). Even after adjusting for age, there was still a significant difference (P = 0.047).Conclusion: Erythrocytes are an independent protective factor for VCI in patients with sWMH. Promoting hematopoietic function may have potential value for prevention of cognitive decline in patients with cerebrovascular disease.

Association Between Immunoglobulin G N-glycosylation and Vascular Cognitive Impairment in a Sample With Atherosclerosis: A Case-Control Study.

BackgroundAtherosclerosis is considered a crucial component in the pathogenesis of decreased cognitive function, as occurs in vascular cognitive impairment (VCI). Inflammation and the immune response play a significant role in the development of many chronic diseases. Immunoglobulin G (IgG) N-glycosylation has been implicated in the development of a variety of diseases by affecting the anti-inflammatory and proinflammatory responses of IgG. This study aimed to investigate the association between IgG N-glycosylation and VCI in a sample of patients with atherosclerosis through a case-control study.MethodWe recruited a total of 330 patients with atherosclerosis to participate in this case-control study, including 165 VCI patients and 165 sex- and age-matched participants with normal cognitive function. The plasma IgG N-glycans of participants were separated by ultrahigh-performance liquid chromatography. An enzyme-linked immunosorbent assay (ELISA) kit was used to determine the corresponding serum inflammatory factors. Atherosclerosis was diagnosed by carotid ultrasound, and the diagnosis of VCI was based on the “Guidelines for the Diagnosis and Treatment of Vascular Cognitive Impairment in China (2019)”. A multivariate logistic regression model was used to explore the association between IgG N-glycans and VCI. We also analyzed the relationship between IgG N-glycans and the inflammatory state of VCI through canonical correlation analysis (CCA).ResultsThrough the multivariate logistic regression analysis, 8 glycans and 13 derived traits reflecting decreased sialylation and galactosylation and increased bisecting GlcNAc significantly differed between the case and control groups after adjusting for confounding factors (P < 0.05, q < 0.05). Similarly, the differences in TNF-α, IL-6, and IL-10 were statistically significant between the case and control groups after adjusting for the effects of confounding factors (P < 0.05, q < 0.05). The CCA results showed that VCI-related initial N-glycans were significantly correlated with VCI-related inflammatory factors (r = 0.272, P = 0.004). The combined AUC value (AUCcombined = 0.885) of 7 initial glycans and inflammatory factors was higher than their respective values (AUCinitial glycans = 0.818, AUCinflammatory factors = 0.773).ConclusionThe findings indicate that decreased sialylation and galactosylation and increased bisecting GlcNAc reflected by IgG N-glycans might affect the occurrence of VCI in patients with atherosclerosis though promoting the proinflammatory function of IgG. IgG N-glycans may serve as potential biomarkers to distinguish VCI in individuals with atherosclerosis.

Association of Serum Interleukin-34 and Insulin Resistance with Cognitive Impairment in Patients with Cerebral Small Vessel Disease.

Insulin resistance (IR) is a key pathological process during the development of cerebral small vessel disease (CSVD) and vascular cognitive impairment (VCI). The triglyceride- glucose index (TyG index) is considered a novel marker of insulin resistance and can represent peripheral tissue insulin sensitivity. Interleukin-34 (IL-34) is a cytokine of the short-chain helical hematopoietic cytokine family and recent studies have shown that its serum levels may represent an important biomarker for atherosclerosis. Here, we aimed to investigate whether the TyG index and serum IL-34 levels were related to VCI in patients with CSVD. This study included a total of 280 CSVD patients. TyG index, clinical baseline data, and fasted venous blood for quantification serum levels of IL-34 were acquired within 24 hours of admission. Multiple logistic regression analysis was applied to analyze the association between potential risk factors and VCI, and receiver operator characteristic (ROC) curve was used to evaluate the diagnostic value of IL-34, TyG index, and their combination for detecting VCI. Among all included CSVD patients, 166 patients (59.3%) were diagnosed with VCI based on the cognitive function scale (MOCA). After adjusting for confounding factors, serum IL-34 levels and TyG index were independently associated with VCI (P<0.05). Using ROC curve analysis, the optimal thresholds for identification of VCI based on serum IL-34 levels and TyG index were 41.57pg/ml (area under the curve (AUC): 0.723; sensitivity 76.5%; specificity 64%) and 3.94 (AUC:0.727; sensitivity 72.3%; specificity 62.3%), respectively. This study demonstrated that IL-34 and TyG index are closely associated with VCI in CSVD patients and may represent clinical therapeutic targets for CSVD.

Meta-Analysis of Risk Factors of Vascular Cognitive Disorder in Acute Cerebral Infarction Patients

Objectives: To identify the main risk factors of vascular cognitive impairment in patients with acute cerebral infarction by Meta-analysis, and provide references for the effective prevention of the cognitive impairment in stroke patients. Methods: To retrieve the observational research literatures that refer to the risk factors of vascular cognitive impairment in patients with ischemic stroke, which are published on China National Knowledge Infrastructure (CNKI), Wanfang and Weipu Chinese databases. The screening and data extraction of these literatures are independently completed by two researchers, who also give the quality evaluation of the literatures according to the evaluation criterion of the Australian JBI Evidence-Based Health Care Center. Then, Meta-analysis is conducted by using Revman5.3 software. Results: There are twenty-eight articles selected from 1507 literatures, with a total of 10,711 cases and 50 risk factors included. Among them, there are combined effects of ten factors which have statistical significance, such as infarction area, alcohol consumption, smoking, hyper homocysteinemia, hypertension, diabetes mellitus, age, history of cerebral infarction, hyperlipoidemia and education level. The relational merging OR value and 95% CI between the type-variable factors and cognitive impairment are 3.25 (1.84, 5.76); 2.98 (2.58, 3.45); 2.79 (1.69, 4.59); 2.35 (1.93, 2.85); 2.25 (1.86, 2.71); 2.14 (2.10, 2.18); 1.82 (1.62, 2.03); 1.54 (1.24, 1.92); 1.45 (1.34, 1.56); 0.83 (0.78, 0.89). Conclusion: Infarction area, alcohol consumption, smoking, hyper homocysteinemia, hypertension, diabetesmellitus, age, history of cerebral infarction, hyperlipoidemia and low education level are the main risk factors for vascular cognitive impairment in patients with acute cerebral infarction. Clinical nursing staff should include it into the routine assessment of patients with acute cerebral infarction and actively prevent and intervene.

Association of lipoprotein a, fibrinogen and D-dimer with vascular cognitive impairment in patients with ischemic cerebral small vessel diseases

Objective To explore the correlation between lipoprotein a (Lpa), fibrinogen (FIB) and D-dimer (D-D) and vascular cognitive impairment in patients with ischemic cerebral small vessel diseases (CSVD). Methods Totally 300 patients with ischemic CSVD who were admitted to the Department of Neurology, Affiliated Hospital of North China University of Science and Technology were selected as the research objects, and 70 healthy outpatients in the same period were selected as the control group.Cognitive function was assessed with Mini Mental State Examination(MMSE). According to the results of MMSE, patients with ischemic CSVD were divided into cognitive normal group (106 cases) and cognitive impairment group (194 cases). The cognitive impairment group was further divided into mild cognitive impairment group (100 cases), moderate cognitive impairment group (60 cases) and severe cognitive impairment group (34 cases). Lpa level was detected by latex immunoturbidimetry, FIB level by coagulation and D-D level by ELISA.The results were compared and analyzed. Results (1) Compared with the control group (Lpa: (101.67±37.37)mg/L, FIB: (3.02±0.67) g/L, D-D: (231.49±95.00) mg/L), the levels of Lpa, FIB and D-D in normal group(Lpa: (150.58±89.55) mg/L, FIB: (3.48±0.80) g/L, D-D: (287.79±125.25)mg/L)and cognitive impairment group(Lpa: (257.98±189.23)mg/L , FIB: (3.86±0.97) g/L, D-D: (347.23±120.69) mg/L)increased significantly (all P<0.01). Compared with the cognitive normal group, the levels of Lpa, FIB and D-D in cognitive impairment group increased significantly (all P<0.01). (2) Compared with mild cognitive impairment group (Lpa: 169.08±51.63 mg/L, FIB: (3.10±0.69)g/L, D-D: (288.91±92.58)mg/L), the levels of Lpa, FIB and D-D of in moderate cognitive impairment group (Lpa: (236.78±107.15) mg/L, FIB: (3.52±0.67) g/L, D-D: (345.03±132.68) mg/L), severe cognitive impairment group (Lpa: (292.65±108.19) mg/L, FIB: (4.04±1.08) g/L, D-D: (401.58±84.87) mg/L) increased significantly (all P<0.01). Compared with the moderate cognitive impairment group, the levels of Lpa, FIB and D-D in the severe cognitive impairment group increased significantly (all P<0.01). (3) The ROC curve was fitted with cognitive impairment as state variable.The area under the ROC curve of Lpa was 0.706, P<0.01, 95% CI was (0.646-0.766), the area under the ROC curve of FIB was 0.613, P=0.001, 95% CI was (0.548-0.679), and the area under the ROC curve of D-D was 0.670, P<0.01, 95% CI was (0.604-0.736). (4) Lpa, FIB and D-D were positively correlated with the degree of cognitive impairment in patients with ischemic cerebral small vessel diseases (rLpa=0.522, P<0.01; rFIB=0.410, P<0.01; rD-D=0.488, P<0.01). Conclusion Serum Lpa, FIB and D-D are closely related to the degree of vascular cognitive impairment and cognitive impairment in patients with ischemic CSVD, which may be involved in the occurrence and development of cognitive impairment.Detection of serum levels of Lpa, FIB and D-D is of great clinical value in the early diagnosis, assessment and treatment of cognitive impairment in ischemic CSVD. Key words: Ischemic cerebral small vessel diseases; Vascular cognitive impairment; Lipoprotein a; Fibrinogen; D-dimer

The Clinical Phenotype of Vascular Cognitive Impairment in Patients with Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus (T2DM) increases the risk of vascular cognitive impairment (VCI). It is unknown which type of vascular lesions and co-morbid etiologies, in particular Alzheimer's disease pathology, are associated with T2DM in patients with VCI, and how this relates to cognition and prognosis. To compare brain MRI and cerebrospinal fluid (CSF) markers, cognition, and prognosis in patients with possible VCI with and without T2DM. We included 851 memory clinic patients with vascular brain injury on MRI (i.e., possible VCI) from a prospective cohort study (T2DM: n = 147, 68.4±7.9 years, 63% men; no T2DM: n = 704, 67.6±8.5 years, 52% men). At baseline, we assessed between-group differences in brain MRI abnormalities, CSF markers of Alzheimer's disease, and cognitive profile. After two years follow-up, we compared occurrence of cognitive decline, stroke, and death. The distribution of clinical diagnoses did not differ between patients with and without T2DM. T2DM patients had more pronounced brain atrophy (total and white matter volume), and more lacunar infarcts, whereas microbleeds were less common (all p < 0.05). CSF amyloid-β levels were similar between the groups. T2DM patients performed worse on working memory (effect size: - 0.17, p = 0.03) than those without, whereas performance on other domains was similar. During follow-up, risk of further cognitive decline was not increased in T2DM.∥Conclusion: In patients with possible VCI, presence of T2DM is related to more pronounced brain atrophy and a higher burden of lacunar infarcts, but T2DM does not have a major impact on cognitive profile or prognosis.∥.

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.

Middle Cerebral Artery Pulsatility Index as Predictor of Cognitive Impairment in Hypertensive Patients.

Background: Cognitive impairment is a manifestation of cerebrovascular disease regarding hypertension and other degenerative diseases which has become a global health issue due to increased life expectancy. Recently, the gold standard used for diagnosing vascular cognitive impairment (VCI) has required a combination of the neurophysiological approach and magnetic resonance imaging (MRI). The Neurosonological approach, involving measuring the pulsatility index (PI) of the middle cerebral artery (MCA) using Trans Cranial Doppler (TCD), can hopefully be used as an affordable alternative predictor of VCI in patients with hypertension.Methods: A cross-sectional study was conducted at the Outpatient Clinic of the Department of Neurology in Ciptomangunkusumo Hospital, Jakarta. Sixty-six hypertensive subjects with no macrovascular complication were selected and screened using the Montreal Cognitive Assesment-Indonesia version (MoCA-Ina) to determine their cognitive status. Subjects were categorized into two groups; subjects with scores ≥26 were classified as the normal cognitive group, while subjects with scores <26 were classified as the cognitive impairment group. Both groups then underwent TCD examination to determine bilateral MCA PI.Results: There was a significant difference between MCA PI in both groups; it was higher in the cognitive impairment group than normal group (p < 0.001). Subjects with an increased left MCA PI were more likely to suffer cognitive impairment than those with an increased right MCA PI.Conclusion: MCA PI can be used as a predictor for cognitive impairment in hypertensive subjects.

Cognitive syndromes after the first stroke.

The aim of this study is to determine impairments of certain cognitive functions in certain vascular cognitive syndromes and to identify predictors of dementia. One-year prospective study included 275 patients, who were hospitalized at the Department of Neurology Tuzla and therefore fulfilled certain criteria. Patients were divided into following subgroups of vascular cognitive impairment (VCI): dementia of strategic infarct (DSI), cortical dementia (CD), sub cortical dementia (SCD), hemorrhagic dementia (HD), and patients without dementia. Each of the patients underwent the clinical examination and scoring with appropriate measurement scales. Some of the types of VCI were verified in 190 (69%) patients, and the most common was SCD (58%). There was statistically significant connection between the level of intelligence and occurrence of VCI in patients after stroke (p < 0.001). We found significant connection between occurrence of dementia and impairment in narrative memory, numerical memory, visual perceptive, and visual constructive functions in patients with dementia compared with non-demented (p = 0.0001). The executive functions were statistically impaired in patients with CD (p = 0.004) and SCD (p < 0.001). Patients without dementia have significantly better quality of life than the demented ones (p < 0.0001). The algorithm "tree of decision" can help us in the prediction of dementia based on the impairment of certain cognitive functions. Vascular cognitive syndromes are common after stroke. Some of the cognitive functions are significantly impaired in patients with dementia. Impairment of the certain cognitive functions can help in predicting the onset of dementia. Patients without dementia have better quality of life.

Possible mechanisms of cognitive dysfunction in patients with chronic forms of cerebrovascular diseases

Cognitive impairment (CI) is a basis for the clinical presentation of chronic cerebral ischemia (CCI). However, the role of the mechanisms of inflammation and angiogenesis in the origin of CI is unclear, as is its relationship to the number and localization of foci during a neuroimaging examination. Objective : to investigate the relationship between the presence of CI, focal brain tissue changes, and the plasma and serum levels of vascular endothelial growth factor (VEGF) and monocyte chemoattractant protein-1 (MCP-1) in patients with CCI. Patients and methods . Examinations were made in 59 patients with CCI and in 20 apparently healthy individuals. The investigators evaluated the cognitive status using the Mini-Mental State Examination (MMSE) and the clock drawing test), performed brain magnetic resonance imaging (MRI), duplex scanning of cerebral vessels, and determined laboratory indicators: the serum levels of MCP-1 and C-reactive protein, and the serum and plasma concentrations of VEGF. Results . The patients with CI were found to have higher values of inflammatory markers, lower serum and plasma concentrations of angiogenic factors, and a greater number of focal changes on MRI than those without CI (5.06±0.23 and 2.36±0.3 scores, respectively; p<0.05). Imbalance of angiogenic and antiangiogenic factors can cause disease progression and moderate vascular CI in patients with CCI.

Correlation of Stress Hyperglycemia after Ischemic Stroke with Early Vascular Cognitive Impairment.

Objective To investigate the influence and forecast value of stress hyperglycemia on the early vascular cognitive impairment (VCI) in stroke patients.Methods Totally 422 patients with acute non-diabetic stroke were divided into three groups according to the fasting plasma glucose level:the euglycemia group (<6.1 mmol/L),the mild stress hyperglycemia group (6.1-7.0 mmol/L),and the severe stress hyperglycemia group (≥7.0 mmol/L).Mini-mental state examination,Alzheimer's disease rating scale cognitive subscale,and clinical dementia rating scale were used to evaluate early cognition in post-stroke patients,and patients were divided into three groups accordingly:normal cognitive function group,mild VCI group,and vascular dementia group.Correlation analysis was carried out on the level of stress hyperglycemia and the degree of VCI.Results Of these 422 patients,stress hyperglycemia was identified in 62 cases (14.7%).The risk of stress hyperglycemia was higher in patients with a high degree of education [(8.39±3.85)years vs.(6.62±4.39)years,P=0.037)] or a history of cardiovascular disease (45.2% vs.18.3%,P=0.001).VCI was detected in 270 patients (64.0%).Age,sex,smoking,National Institute of Health Stroke Scale score,Hamilton Depression Rating Scale score,stress hyperglycemia,and history of cardiovascular disease were related with early VCI after non-diabetic ischemic stroke (P<0.05).Multivariate Logistic regression analysis showed that stress hyperglycemia was an independent risk factor for VCI in patients with non-diabetic ischemic stroke (OR=3.086,95% CI=1.065-8.929).The risks of cognitive impairment in the mild stress hyperglycemia group and the severe stress hyperglycemia group were higher than that of the euglycemia group,while it was also higher in the severe stress hyperglycemia group than in the mild stress hyperglycemia group (61.11% vs.75.00% vs.90.91%).Stress hyperglycemia was positively correlated with the high risk of early cognitive impairment in stroke patients (rs=0.185,P=0.007).Conclusion There is a significant correlation between stress hyperglycemia and early VCI after ischemic stroke.

The clinical effects of methylenetetrahydrofolate reductase C677T gene mutation on mild vascular cognitive impairment in patients with cerebral infarction

Objective To study the clinical effects of methylenetetrahydrofolate reductase(MTHFR)C677T gene mutation on mild vascular cognitive impairment(VCI)in patients with cerebral infarction. Methods The prospective study was conducted in 180 patients with atherosclerotic acute cerebral infarction hospitalized from June 2015 to May 2016.180 patients were divided into normal homocysteine(Hcy)group(Hcy 5.46~16.20 μmol / L, n=130)and high Hcy group(Hcy>16.20 μmol / L, n=50). MTHFR C677T genotypes were detected by polymerase chain reaction-restriction endonuclease fragment length polymorphism.The VCI state and risk factors for VCI were analyzed with Montreal Cognitive Assessment scale(MoCA)and Mini Mental State Examination(MMSE)score in patients with acute cerebral infarction on admission and 14 days, 30 days and 90 days after admission. Results MMSE and MoCA scores at 14 days, 30 days, 90 days after admission were lower in high Hcy group than in normal Hcy group(P<0.05 or P<0.01). MMSE and MoCA scores were lower in T/T genotype than in C/C genotype(P<0.05)at 14 day after admission, and lower in C/T genotype than in C/C genotype at 30 day and 90 day follow-up(P<0.05 or P<0.01). Logistic regression analysis showed that Hcy may be independent risk factors for mild VCI(OR=1.274, 95%CI: 1.027~1.264, P=0.018). Conclusions MTHFR C677T gene mutations may cause hyper-homocysteinemia, and promote the emergence of VCI in patients with cerebral infarction.MTHFR C677T gene mutations may be a genetic susceptibility factor for VCI. Key words: Brain infarction; Methylenetetrahydrofolate reductase; Cognition disorders