ABSTRACT
Objective To explore the association between white matter hyperintensities volume and cognitive function in patients with hypertension.Methods Eighty-two patients with hypertension enrolled from the Department of Neurology of Nanjing Drum Tower Hospital from January 2017 to December 2017 were recruited in this study sequentially,who aged between 50 and 80 years.All subjects used automatic white matter quantitative technique to get their personal whole white matter hyperintensities volume,periventricular white matter hyperintensities volume and deep white matter hyperintensities volume.Neuropsychological scales were used to evaluate their global cognitive function,memory function,fluency,executive function and processing speed.The association between white matter hyperintensities volume and cognitive function via linear regression analysis was assessed.To explore whether the association between white matter hyperintensities volume and cognitive function be affected by the duration of hypertension,stratification analyses were conducted using the median of the duration of hypertension as separation.Results After adjusting for age,sex,education,lacunar infarctions and global cortical atrophy grade,the Trail Marking Test (2-1) score which reflects executive function was found to be related to whole white matter hyperintensities volume (standardized beta-value=0.268,P=0.019),periventricular white matter hyperintensities volume (standardized beta-value=0.243,P=0.037) and deep white matter hyperintensities volume (standardized beta-value=0.243,P=0.021).Victorial Snoop Test-2 score which reflects processing speed was found to be related to periventricular white matter hyperintensities volume (standardized beta-value=0.270,P=0.023).After additional adjusting for the duration of hypertension,the Trail Marking Test (2-1) score was still found to be related to whole white matter hyperintensities volume (standardized beta-value=0.277,P=0.016),periventricular white matter hyperintensities volume (standardized beta-value=0.251,P=0.032) and deep white matter hyperintensities volume (standardized beta-value=0.248,P=0.019).The Victorial Stroop Test-2 score was found to be related to whole white matter hyperintensities volume (standardized beta-value=0.237,P=0.041) and periventricular white matter hyperintensities volume (standardized beta-value=0.290,P=0.013).Conclusion Whole white matter hyperintensities volume,periventricular white matter hyperintensities volume and deep white matter hyperintensities volume are related to executive function,periventricular white matter hyperintensities volume is also related to processing speed in patients with hypertension,and the association between white matter hyperintensities volume and cognitive domain is not influenced by the duration of hypertension.
ABSTRACT
Objective To investigate the effect of hypertension on white matter microstructure and its correlation with cognitive function using automated fiber-tract quantification.Methods Consecutive subjects visited Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School between January 2017 and July 2018 were collected.They were divided into hypertension without cognitive impairment (HTN-nonCI) group (n =44),hypertension with cognitive impairment (HTN-CI) group (n =50),and control group (n =25).The imaging data and neuropsychological scale test results of the subjects were collected.The automated fiber-tract quantification was used to obtain the diffusion parameters of 100 nodes on 20 fiber tracts in the whole brain.The differential segments of each fiber tract diffusion parameter between the control group and HTN-nonCI group,and the HTN-nonCI group and HTN-CI group were compared.Correlation analysis was performed in white matter fiber tracts with significant differences and each cognitive domain between the HTN-nonCI group and the HTN-CI group.Results The fractional anisotropy (FA) of white matter fiber tracts in 3 groups showed a decreasing trend,and the mean diffusion diffusivity (MD) showed an increasing trend.The comparison between the control group and the HTN-nonCI group showed that there were significant differences in the FA values of the midpoint of left thalamic radiation tract partial to brainstem,the genus of corpus callosum near brainstem,and frontal part and and proximal ventricle of splenium of corpus callosum (all P＜0.05);there were significant differences in the MD values of the middle part of left thalamic radiation tract and near the brainstem,the right thalamic radiation tract near the brainstem,the top of left corticospinal tract and near brainstem,the middle hippocampus of right cingulate tract,the middle part of genu of corpus callosum,the splenium of the corpus callosum near the lateral ventricle,the left uncinate tract near the forehead (all P ＜ 0.05).A comparison between the HTN-nonCI group and the HTN-CI group showed that there was significant difference in the FA value between the distributed segments of cingulate gyrus of left cingulate tract and the left inferior fronto-occipital tract near the occipital lobe,in which cingnlate gyrus of left cingulate tract was significantly correlated with the Montreal Cognitive Assessment Scale score (standardized3 =0.268,P =0.029);there were significant differences in the right thalamic radiation tract near the brainstem,the forehead and proximal ventricle of splenium of the corpus callosum,and the scattered distribution segments of the right inferior longitudinal fasciculus,in which the right inferior longitudinal fasciculus was significantly correlated with memory (standardizedβ=-0.243,P=0.047) and executive function (standardizedβ=-0.284,P=0.021).Conclusions Microstructural integrity of white matter was generally destroyed in patients with hypertension,but some segments were more susceptible to hypertension.The integrity of cingnlate gyrus of cingulate tract was significantly correlated with the overall cognitive function.The integrity of inferior iongitudinal fasciculus was significantly correlated with the executive function and memory.
ABSTRACT
Objective To investigate the correlation between white matter lesions (WMLs) score and volume and cerebral microbleeds (CMBs) in patients with cerebral small vessel disease (CSVD).Methods Patients with non-acute lacunar infarction from the CSVD Follow-up Cohort Study in the Affiliated Drum Tower Hospital of Nanjing University from January 2017 to December 2017 were enrolled.The relevant clinical data were collected and 3.0 T cranial MRI examinations were performed,including T1-weighted imaging,T2-weighted imaging,fluid attenuated inversion recovery (FLAIR) sequence,susceptibility-weighted imaging,and diffusion-weighted imaging.W2MHS software was used to quantify the volume of WMLs.Fazekas method was used to score periventricular and deep WMLs separately.The number of CMBs was counted visually.Multivariate logistic regression analysis was used to determine the independent influencing factors of CMBs.Multivariate linear regression equation (stepwise method) was used to analyze the independent influencing factors of the number of CMBs.Medcalc 18.6 was used to deseribe receiver operating characteristic (ROC) curve.The predictive value of WMLs Fazekas scores and volumes for CMBs was evaluated.Results A total of 82 patients were enrolled,including 31 (37.8％) in CMBs group and 51 (62.2％) in non-CMBs group.The comparison between the two groups showed that smoking,use of antiplatelet agents,history of transient ischemic attack (TIA) or lacunar infarction,larger WMLs volume,higher levels of triacylglycerol,and lower levels of high-density lipoprotein cholesterol might be the risk factors for CMBs.Multivariate logistic regression analysis showed that higher Fazekas score (odds ratio 1.908,95％ confidence interval 1.210-3.009;P=0.005) and larger WMLs volume (odds ratio 4.620,95％ confidence interval 1.279-16.683;P =0.019) were the independent risk factors for CMBs.Multiple linear regression analysis showed that Fazekas score (r =0.379,P =0.001) and WMLs volume (r =0.260,P =0.023) were independently and positively correlated with the number of CMBs.The ROC curve analysis showed that the area under the curve of Fazekas scores predicting CMBs was 0.768 (95％ confidence interval 0.654-0.881).The optimal cut-off value was 3,the sensitivity was 61.29％,and the specificity was 90.20％.The area under the curve of WMLs volume predicting CMBs was 0.783 (95％ confidence interval 0.677-0.867).The optimal cut-off value was the volume of WMLs reaching 2 137.96 mm3.The sensitivity was 73.33％,and the specificity was 84.00％.Conclusion WMLs and CMBs had significant correlation in patients with CSVD.The WMLs Fazekas score and volume quantification are expected to serve as the alternative indicators for the urgent assessment of CMBs.
ABSTRACT
Hypertension has become one of the most common chronic diseases that endanger the physical and mental health of elderly populations.The relationship between hypertension and cognitive impairment has become a hot research topic in recent years.Not only does systolic pressure,diastolic pressure and pulse pressure affect cognitive function,but also blood pressure fluctuation and related genetic factors can lead to cognitive decline.However,the relationship between hypertension and cognitive impairment,the related mechanisms,and whether antihypertensive therapy can delay the progression of cognitive impairment are not fully understood.This article reviews the above problems in order to provide a reference for the prevention of cognitive impairment in patients with hypertension.
ABSTRACT
Objective To investigate the correlation between total MRI cerebral small vessel disease (SVD) score and overall cognitive functions and different cognitive domains.Methods Form January 2017 to June 2018,subjects aged 45-80 years and without dementia were recruited from the Neurology clinic,wards,Nanjing Drum Tower Hospital,the Affdiated Hospital of Nanjing University Medical School and communities.The overall cognitive function,executive function,processing speed,working memory,language function,visual-spatial ability,and depression were assessed with the related scale in all subjects.3.0 T MRI (T1-weighted imaging,T2-weighted imaging,diffusion-weighted imaging,liquid-attenuated inversion recovery sequence,and susceptibility-weighted imaging) was used to identify white matter hyperintensities,lacunar foci,microbleeds,and enlargement of perivascular space.The total SVD score was calculated.Results A total of 217 subjects were enrolled,including 24 normal middle-aged and elderly,65 at risk of cerebrovascular disease,128 with SVD changes in imaging findings.Multivariate linear regression analysis showed that after adjusting for possible confounding factors,the total SVD score and overall cognitive function (β =-0.105,95％ confidence interval [CI]-0.201--0.010;P =0.030),executive function (β =-0.135,95 ％ C!-0.216--0.054;P =0.001),and language function (β =-0.095,95％ CI-0.182--0.008;P =0.032) showed a significantly independent negative correlation.Conclusion The total SVD score was negatively correlated with the overall cognitive function,executive function,and impairment of language function.
ABSTRACT
OBJECTIVE To investigate the manifestation,fungal spectrum,diagnosis,antifungal therapy and(outcome) of deep fungal infection(DFI) in patients with hematopoietic malignancies.METHODS Fifty-two(patients) of SFI admitted in Shandong Provincial Hospital during Oct 1998 to Sept 2004 were enrolled in this(investigation,) including 34 males and 18 females with mean age of 54 years old.Clinical data,such as manifestation,fungal(spectrum,) treatment and outcome,were observed prospectively and retrospectively.RESULTS Lower respiratory tract,gastrointestinal tract,urinary tract and blood were the main DFI infection sites by order of prevalence.The clinical manifestation was various among cases.Pathogen detection determined the subtypes of fungi were Candida albicans(57.14%),C.tropicalis(21.43%),yeast(47.14%),C.parapsilosis(7.14%),and Aspergillus((5.36%).) Nystatin,fluconazole,flucytosine,and(amphotericin) B were used alone or in(combination) to treat DFI.The rates of curing,improvement and death were 44.23%,23.08% and 32.69%,(respectively).(Among) 52 cases,25(48.08%) were occurred during Oct 2002 to Sept 2004,compared with 27((51.92%)) during Oct 1998 to Sept 2002,suggested the elevated incidence of DFI.CONCLUSIONS The incidence of DFI in patients with hematopoietic malignancies is increasing these years.The clinical manifestation of DFI may be nonspecific.It is critical to pay more attention to the fungal infection among the high-risk patients,therefore fungus detection from various(samples) should be recommended for the sake of early diagnosis of DFI. Though(C.albicans) remains the top in pathogen spectrum analysis,infection of other fungi tends to increase.The mortality of DFI is still very high thus more investigations about early diagnosis and treatment of DFI should be conducted.