Vascular cognitive impairment / 中华神经科杂志

The term of vascular cognitive impairment (VCI) has been constantly evolved and updated. The latest definition refers to the contribution of stroke and subclinical vascular brain injury that resulted from vascular pathology and its risk factors, to the cognitive impairment syndrome involving at least one domain, ranging from mild cognitive impairment to dementia, as well as mixed cognitive impairment, including Alzheimer′s disease. This article presents the epidemiology, etiology, pathogenesis, classification, clinical manifestations, auxiliary examination, diagnosis, prevention and treatment of VCI.

The study of cerebral blood flow perfusion imaging in language related brain areas of post stroke aphasia patients / 中华神经科杂志

Objective:To evaluate and quantify the degree of language impairment by obtaining the cerebral blood flow in the main language functional areas of aphasia patients after stroke with arterial spin labeling sequence, so as to make aphasia evaluation more objectively, accurately and effectively.Methods:From May 2016 to October 2019, 22 patients with aphasia after stroke and 22 healthy controls were collected from the Department of Neurology, the First Affiliated Hospital of Zhejiang University, for multimode MR scanning, and the patients were evaluated by aphasia scale during hospitalization. The classic language related brain area and potential language related brain area were selected as the regions of interest to extract the local mean cerebral blood flow. The differences of cerebral blood flow between the two groups were compared, and the correlation between the cerebral blood flow of each region of interest and the sub items of multiple language scales was analyzed.Results:Compared with the control group, the cerebral blood flow of the inferior parietal gyrus （AAL-11，(39.18±3.85) ml·100 g -1·min -1vs (50.41±1.93) ml·100 g -1·min -1， t=2.605）, angular gyrus （AAL-13，(39.90±3.29) ml·100 g -1·min -1vs (47.86±1.93) ml·100 g -1·min -1, t=2.087） in the patients was obviously decreased; In the relevant brain areas of listening comprehension, the cerebral blood flow of the inferior parietal gyrus (AAL-61, (33.86±4.15) ml·100 g -1·min -1vs (44.31±2.39) ml·100 g -1·min -1, t=2.179), superior marginal gyrus (AAL-63, (36.49±4.40) ml·100 g -1·min -1vs（50.17±2.26） ml·100 g -1·min -1, t=2.765), and angular gyrus (AAL-65, (35.56±4.24) ml·100 g -1·min -1vs(48.98±2.32) ml·100 g -1·min -1, t=2.777), Heschl gyrus (AAL-79, (47.30±5.11) ml·100 g -1·min -1vs（62.54±2.45） ml·100 g -1·min -1, t=2.689) and superior temporal gyrus (AAL-81, (43.56±4.82) ml·100 g -1·min -1vs (56.29±2.06) ml·100 g -1·min -1, t=2.429) of the patients was also decreased to different degrees ( P<0.05). In addition, the cerebral blood flow of the left insula (AAL-29, (46.59±3.76) ml·100 g -1·min -1vs (55.74±2.12) ml·100 g -1·min -1, t=2.120) and the rolandic island (AAL-17, (39.71±3.81) ml·100 g -1·min -1vs (52.48±2.01) ml·100 g -1·min -1, t=2.968)cover in the patients was also lower than that in the control group significantly ( P<0.05). The results of correlation analysis showed that there was a significant positive correlation ( P<0.05) between the brain blood flow of the left inferior frontal gyrus, the triangle of inferior frontal gyrus, the insular lobe, the inferior parietal lobe, the bilateral superior marginal gyrus and the sub item scores of the language scale in the patients. Conclusions:The decrease of cerebral blood flow is the potential cause of the decrease of language function in aphasia patients after stroke. The decrease of cerebral blood flow in six brain regions, including the frontal inferior gyrus, the frontal inferior gyrus triangle, the insular lobe, the left and right superior marginal gyrus and the inferior parietal lobe, can be used as an objective quantitative index to reflect the level of naming function.

Neuroimaging in the diagnosis and differentiation of Alzheimer′s disease / 中华神经科杂志

Neuroimaging is of great value in the diagnosis and differentiation of Alzheimer′s disease. Structural imaging, especially structural magnetic resonance, can show the characteristic changes of brain atrophy in patients with Alzheimer′s disease, and effectively identify lesions in the brain. Functional imaging, mainly the molecular imaging of positron emission tomography can achieve intracranial retention of tracer that binds to the β-amyloid, which is of great value for the pathophysiological diagnosis of Alzheimer′s disease. This article introduces the application value of structural and functional magnetic resonance imaging, positron emission tomography, single-photon emission computed tomography and other imaging examinations in the diagnosis and differentiation of Alzheimer′s disease.

Application progress of arterial spin labeling technology in the field of cognitive dysfunction / 国际脑血管病杂志

Arterial spin labeling (ASL) technology is a popular technique for evaluating and studying cerebral perfusion in recent years. It can sensitively detect the abnormal cerebral perfusion and effectively avoid the potential risks caused by exogenous contrast agents in other tests. Detection of the abnormal cerebral blood flow perfusion by ASL technology can early predict cognitive decline in normal elderly, explore the pathogeneses of mild cognitive dysfunction and Alzheimer's disease, and evaluate the cerebral blood flow around the ischemic focus and the establishment of collateral circulation in patients with aphasia after stroke. At the same time, it is verified that the decrease of cerebral blood flow perfusion is another precipitating factor of primary progressive aphasia except cortex atrophy. Although there are still some limitations, the ASL technology has a good prospect in the application of cognitive disorders.

Progress of anesthetic strategy of endovascular treatment for acute ischemic stroke / 中华神经科杂志

Currently,the ideal anesthetic approach for the endovascular treatment of acute ischemic stroke remains unknown.Most retrospective studies and meta-analysis report worse outcomes from general anesthesia than from conscious sedation during endovascular treatment.However,series of randomized controlled trials have not shown the advantages of conscious sedation.The choice of anesthetic strategy should continue to be individualized in clinical practice.In order to provide references for clinician,the advantages and disadvantages of general anesthesia and conscious sedation for the endovascular treatment of acute ischemic stroke were reviewed.

Cerebral infarction following facial autologous fat transplantation: report of two cases / 中华神经科杂志

Facial autologous fat transplantation is a common aesthetic procedure.Although this procedure is generally regarded as safe,several patients have experienced acute cerebral infarction after fat particles were incorrectly injected into the blood vessel.We report two cases of cerebral infarction following facial autologous fat transplantation:one patient suffered massive cerebral infarction due to the occlusion of internal carotid artery by fat embolus and died of stroke related complication,the other young women experienced acute ischemic stroke and ophthalmic artery embolism during this procedure and remained permanent blindness of right eye.Therefore,when a patient presents abrupt mental change,hemiplegia,blindness during autologous fat particle injection,doctors must consider the complication of cerebral infarction.

Application of exercise test in patients with paroxysmal kinesigenic dyskinesia / 中华神经科杂志

Objective To explore the application of the exercise test (ET) in paroxysmal kinesigenic dyskinesia (PKD).Methods We conducted the ET in 33 controls and 45 PKD patients following standardized protocols,and the decrement in the amplitude and in the area of compound muscle action potentials (CMAP) after long ET and other seven parameters were calculated and compared in both groups,and the normal range of parameters was defined as the mean ± two standard deviation of the control values.Results According to the control group,the normal range of the change in the amplitude of CMAP immediately after short ET was-13％-27％ and the normal range of decrement in the amplitude of CMAP after long ET was less than 33％.And the ET was abnormal in 16 of the 45 PKD patients (36％).Comparing the nine parameters between two groups,we found that both the decreases of the amplitude (25.5％ ±13.4％ vs16.2％ ±8.6％,t=-3.72,P=0.00) and the area(31.8％ ±16.3％ vs19.0％ ± 16.8％,t =-2.39,P =0.02) of CMAP after long ET in PKD patients were larger than those in controls.No statistically significant difference was found between 19 non-ion channel disease patients and 14 normal controls.No statistically significant difference was found between the nine parameters in 27 PKD patients before and after medication,though all the patients had obvious clinical improvement.Conclusion We found that abnormal ET may appear in PKD patients,and this finding hinted that abnormal muscle membrane excitability might be an underlying mechanism responsible for PKD.

The study on the relationship between the levels of serum CysC and cognitive function in patients with acute cerebral lacunar infarction / 中国神经精神疾病杂志

Objective To investigate the relationship between the level of serum cystatin C (CysC) and cognitive function in patients with acute cerebral lacunar infarction caused by small vessel disease . Methods One hundred twen-ty-three patients with acute cerebral lacunar infarction were divided into 3 groups according to serum cystatin C level. Patients were further divided into normal group (n=64), vascular mild cognitive impairment (VaMCI) group(n=36),and vascular dementia( VaD) group (n=23). The CysC, estimated glomerular filtration rate (eGFR), serum creatinine (Scr), TC, TG, HDL, LDL, fast glucose, HbA1C, NIHSS, MMSE, ADAS-cog score were compared between the 3 groups. Multivari-able logistic regression analysis was used to examine the association of serum CysC with cognitive function. Results Sub-jects with higher CysC levels tended to have lower MMSE score(21.98 ± 6.08 vs. 25.02 ± 4.69 vs. 25.10 ± 3.95 )and higher ADAS-cog score(17.73±14.23 vs. 12.51±10.39 vs. 10.67±7.53). The higher CysC was, the higher SCr and lower eGFR were. Subjects with severer cognition impairment tended to have higher CysC(0.93 ± 0.21 vs. 1.10 ± 0.45 vs. 1.34 ± 0.58). Multivariable logistic regression showed the regression coefficient was 7.06(P<0.05). Conclusion Elevated Serum CysC is one of the risk factors of cognitive dysfunction and associated with the severity in patients with small vessel disease-re-lated acute lacunar cerebral infarction.

Impact analysis of hypocalcemia on the prognosis on intracerebral hemorrhage / 中华老年医学杂志

Objective To prospectively explore the impact of hypocalcemia on the prognostic value of intracerebral hemorrhage.Methods A total of 410 patients consecutively admitted within 12 hours after intracerebral hemorrhage onset were divided into 3 groups based on admission serum calcium:low serum calcium group,normal serum calcium group and high serum calcium group.Baseline characteristics of patients including age,gender,Glasgow coma score(GCS),hematoma volume,etc were collected and analyzed.A follow-up was performed after 6 months.Final outcome was assessed using Glasgow outcome scale(GOS)with a score＞3 regarded as favourable prognosis,a score≤3 as unfavourable prognosis.Results Patients with low serum calcium had lower GOS,bigger hematoma volume,higher rate of operation,higher re-bleeding rate,more unfavourable prognosis than did the other 2 serum calcium groups.Multivariable Logistic regression analysis showed that patients with low serum calcium had poorer prognosis than patients with normal serum calcium after adjusting for other potential confounders(Odds ratio:3.01,95％ confidence interval:1.06-6.12,P＜0.05).Conclusions Hypocalcemia is an independent risk factor for the prognosis of patients with intracerebral hemorrhage.

Clinical analysis of cerebral artery dissection / 中华神经科杂志

Objective To investigate the clinical features,recanalization after medical treatment and clinical outcome of cerebral artery dissection.Methods We reviewed the clinical records of ischemic stroke patients with cerebral artery dissection who visited the First Affiliated Hospital of Zhejiang University between October 2010 and December 2013.We recorded patients' general information,neurological deficit,imaging and clinical treatment.We followed up the patients and statistically analyzed demographic data,recanalization and clinical outcome.Results Among 28 cases of cerebral artery dissection,carotid dissection was the most common (n =19,67.9％),followed by vertebral artery dissection (n =7,25.0％),while the combination of carotid and vertebral artery dissection was rare (n =2,7.1％).In the imaging of cerebral artery dissection,wire beads and occlusion were the most common signs (n =15,53.6％),followed by rat tail sign (n =7,25.0％),aneurysmal dilatation (n =4,14.3％) and dualchamber levy (n =2,7.1％).There were 18 cases of acute cerebral infarction in the 28 studied cases,but there was no significant difference between the degree of stenosis and cerebral infarction caused by cerebral artery dissection.All patients received standard antithrombotic therapy.The difference of the recanalization rate between using anti-platelet aggregation and anticoagulant therapy was not statistically significant (5/6 vs 9/13,P =0.37).Conclusions Although cerebral artery dissection is relatively rare clinically,the typical clinical manifestations of the disease and the characteristic imaging are helpful for the diagnosis.Standardization of antithrombotic treatment is still the first-line treatment of cerebral artery dissection.

Reference jitter values in voluntarily activated extensor digitorum communis muscle recorded with concentric needle electrode / 中华神经科杂志

Objective To validate the technique and establish the reference jitter values in voluntarily activated extensor digitorum communis using a concentric needle electrode (CNE) in healthy Chinese adults.Methods From January to August 2013,forty-two Chinese subjects from healthy examination center of our hospital were prospectively studied,including 20 males and 22 females.Routine electromyogram was tested and jitter was recorded with CNE in all subjects.The jitter values of action potentials pairs of muscle fibers were expressed as the mean consecutive difference (MCD) after 20 analyzed potential pairs.Results The mean MCD of 42 subjects was (23.0 ± 3.1) μs ranging from 17 to 32 μs.The mean jitter value of all 840 potential pairs was (22.8 ± 7.5) μs ranging from 8 to 54 μs.Upper 95％ confidence limits for mean MCD and individual MCD were 29.2 μs and 37.8 μs,respectively.The mean value of MCD of 20 males and 22 females were (23.2 ± 2.8) μs and (22.8 ± 3.4) μs,respectively.There was no statistic difference between genders in MCD (t =0.44,P =0.66).There was no correlation between age and MCD (r =0.11,P =0.48).The mean value of mean interpotential interval was (802 ± 139) μs ranging from 541 to 1 160 μs.Conclusion The present study confirms the suitability of jitter analysis with CNE,which can serve as an objective and valuable method for testing the function of neuromuscular conjunctions.

Jitter analysis with concentric needle electrodes in the extensor digitorum communis for the diagnosis of myasthenia gravis: a pilot study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Single-fiber electromyography is the most sensitive neurophysiological test for the diagnosis of myasthenia gravis (MG), but its use is limited by the potential risk of transmission of infections. Jitter analysis with disposable concentric needle electrodes (CNEs) is therefore being investigated. This pilot study aimed to evaluate jitter analysis with CNEs for the diagnosis of MG.</p><p><b>METHODS</b>Forty-two healthy Chinese volunteers and 44 MG patients were prospectively enrolled. MG patients were classified according to the Osserman classification, and acetylcholine receptor antibody titer was measured. Jitter analysis with CNEs in the extensor digitorum communis and repetitive nerve stimulation (RNS) testing were performed. Jitter was expressed as the mean consecutive difference (MCD), and 20 action potential pairs were analyzed in each subject. The mean MCD in each subject and the mean individual MCD of all action potential pairs were compared between groups.</p><p><b>RESULTS</b>The mean MCD and mean individual MCD were higher in MG patients ((42.3 ± 20.0) µs and (42.2 ± 26.0) µs) than in healthy volunteers ((23.0 ± 3.1) µs and (22.8 ± 7.5) µs). The area under the receiver operating characteristic curve for the mean MCD of MG patients and healthy volunteers combined was 0.85. The mean MCD and mean individual MCD were higher in generalized MG patients ((64.1 ± 18.5) µs and (63.6 ± 30.0) µs) than in ocular MG patients ((33.1 ± 12.0) µs and (33.2 ± 17.6) µs), and were higher in MG patients with abnormal RNS results ((57.2 ± 18.3) µs and (57.3 ± 29.2) µs) than in MG patients with normal RNS results ((32.9 ± 14.8) µs and (32.7 ± 18.3) µs). Abnormal RNS results were observed in 38.60% (17/44) of MG patients and abnormal jitter were observed in 72.70% (32/44) of MG patients.</p><p><b>CONCLUSION</b>Jitter analysis with CNEs is feasible for the diagnosis of MG.</p>

The association between plasma neurotransmitters levels and depression in acute hemorrhagic stroke / 中华内科杂志

Objective To explore the relation between plasm neurotransmitters (Glutamic acid,GAA; γ-aminobutyric acid,GABA; 5-hydroxytryptamine,5-HT; and noradrenaline,NE) and depression in acute hemorrhagic stroke.Methods Objectives were screened from consecutive hospitalized patients with acute stroke.Fasting blood samples were taken on the day next to hospital admission,and neurotransmitters were examined by the liquid chromatography-high resolution mass spectrometry (LC-HRMS).The fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-Ⅳ) was used to diagnose depression at two weeks after onset of stroke.The modified Ranking Scale (mRS) was followed up at 1 year.Pearson test was used to analyse the correlation between serum concentration of neurotransmitters and the Hamilton Depression scale-17items (HAMD-17) score.Logistic regression was used to analyse the relation of serum concentration of neurotransmitters and depression and outcome of stroke.Results One hundred and eightyone patients were included in this study.GABA significantly decreased [6.1 (5.0-8.2) μg/L vs 8.1 (6.3-14.7) μg/L,P ＜ 0.05] in patients with depression in hemorrhagic stroke,and there was no significant difference in GAA,5-HT,or NE.GABA concentration was negatively correlated with HAMD-17 score (r =-0.131,P ＜ 0.05) ; while concentration of serum GABA rose by 1 μg/L,risk of depression in acute phase of hemorrhagic stroke was reduced by 5.6％ (OR 0.944,95％ CI 0.893-0.997).While concentration of serum GAA rose by 1 μg/L,risk of worse outcome at 1 year was raised by 0.1％,although a statistic level was on marginal status (OR 1.001,95％ CI 1.000-1.002).Conclusions In patients with depression in the acute phase of hemorrhagic stroke,there was a significant reduction in plasm GABA concentration.GABA may have a protective effect on depression in acute phase of hemorrhagic stroke.Increased concentrations of serum GAA may increase the risk of worse outcomes at 1 year after stroke.

Clinical observation of short term prognosis of acute severe stroke patients with early enteral and parenteral nutrition / 中华神经科杂志

Objective To investigate the short-term prognosis of acute severe stroke patients treated with early partly of enteral nutrition followed by parenteral nutrition,only early enteral nutrition or only conventional family feeding.Methods According to stratified random method,97 severe acute stroke patients were divided into three groups,including early partly enteral nutrition and parenteral nutrition therapy group (study group,33 cases),only early enteral nutrition group (32 cases),and only conventional family feeding group (32 cases).The nutritional status,mortality,and incidence of infection were observed in the three groups at 21 days; NIH Stroke Scale (NIHSS) and Barthel Index at 21 days were compared among the three groups,and Modificied Rankin Scale (mRS) were compared at 90 days.Results At 21 days,the nutritional parameters including triceps skinfold thickness,mid-arm muscular circumference,hemoglobin,serum albumin,serum prealbumin and triglycerides in the study group were better than that in the other two groups.The incidence of malnutrition(10.0％ (3/30),37.5％ (9/24),12/19) and infection (18.2％ (6/33),40.6％ (13/32),56.3％ (18/32)) among the three groups were significantly different (x2 =15.2417,P =0.0005 ; x2 =10.1030,P =0.0064).The mortality (9.1％ (3/33),25.0％ (8/32),40.6％(13/32); x2 =8.6777,P =0.0131) and the NIHSS score (11.51 ±2.68,13.22 ±2.71,14.48 ± 2.55 ;F =7.86,P =0.0008) in the intervention group were lower than that in the other two groups.However,the Barthel Index had no significant difference among the three groups.At 90 days,the mRS grade 0 to l and the mRS grade 2 to 3 had no significant difference among the three groups; However,the mRS grade 4 to 5 among the three groups were statistical difference.Conclusion The early partly enteral nutrition combined with the stage of parenteral nutrition therapy can improve the short-term prognosis of severe acute stroke,though it cannot improve the Barthel Index on the 21th day.

Application of debate in case based learning in clinical teaching of neurology / 中华医学教育探索杂志

Case based learning(CBL)is one of the teaching modes in clinic education and it is important to explore its teaching methods and qualities.This article discussed on how to use debate in CBL in neurology teaching for seven-year-program students including its organization,topic choosing,rules and specific process in order to provide references for teaching reform.

NADPH oxidase and cerebral ischemia-reperfusion injury / 国际脑血管病杂志

NADPH oxidases are a family of multi-subunit enzyme eomplexes.It catalyzes the production of reactive oxygen species (ROS).A large number of studies have shown that oxidative stress plays a very important role in cerebral ischemia-reperfusion injury,and the find of the expression changes about NADPH oxidase after cerebral ischemia may provide a new idea for the prevention and treatment of ischemic stroke.NADPH oxidase may become a new therapeutic target.

Clinical analysis of nine cases of paroxysmal exercise-induced dystonia / 华中科技大学学报（医学）（英德文版）

This study was aimed to analyze the clinical features of paroxysmal kinesigenic dyskinesia (PKD) and extend the understanding of this disease. From August, 2008 to October, 2010, 9 patients were diagnosed with PKD in the Department of Neurology of the First Affiliated Hospital of Zhejiang University, China. The data involving clinical demographic characteristics, somatosensory evoked potentials, results of electromyography, video electroencephalography (EEG), brain magnetic resonance imaging (MRI) and computerized tomography (CT) were collected. All PKD patients exhibited unilateral or bilateral recurrent episodic dyskinetic attacks triggered by sudden voluntary movements. The duration of the attacks ranged from several seconds to one minute. The attack frequency ranged from approximately once in several months to more than 10 times in a day. Patients suffered from no conscious disorders during the attack, and no neurological signs were found during the period between attacks. No abnormal somatosensory evoked potentials were found. Routine EEG, video EEG monitoring or brain imaging showed normal findings. Classical treatment for anti-epilepsy, including carbamazepine and topiramate, was administered to the patients and proved to be effective. It was concluded that PKD is characteristically triggered by sudden voluntary movement; no abnormal electroneurophysiological findings are observed in PKD, and antiepileptic drugs are effective in treating the disorder.

Clinical analysis of nine cases of paroxysmal exercise-induced dystonia / 华中科技大学学报（医学）（英德文版）

This study was aimed to analyze the clinical features of paroxysmal kinesigenic dyskinesia (PKD) and extend the understanding of this disease. From August, 2008 to October, 2010, 9 patients were diagnosed with PKD in the Department of Neurology of the First Affiliated Hospital of Zhejiang University, China. The data involving clinical demographic characteristics, somatosensory evoked potentials, results of electromyography, video electroencephalography (EEG), brain magnetic resonance imaging (MRI) and computerized tomography (CT) were collected. All PKD patients exhibited unilateral or bilateral recurrent episodic dyskinetic attacks triggered by sudden voluntary movements. The duration of the attacks ranged from several seconds to one minute. The attack frequency ranged from approximately once in several months to more than 10 times in a day. Patients suffered from no conscious disorders during the attack, and no neurological signs were found during the period between attacks. No abnormal somatosensory evoked potentials were found. Routine EEG, video EEG monitoring or brain imaging showed normal findings. Classical treatment for anti-epilepsy, including carbamazepine and topiramate, was administered to the patients and proved to be effective. It was concluded that PKD is characteristically triggered by sudden voluntary movement; no abnormal electroneurophysiological findings are observed in PKD, and antiepileptic drugs are effective in treating the disorder.

Retrospective study of high intraarterial signals on conventional magnetic resonance imaging in acute ischemic stroke patients / 中华神经科杂志

ObjectiveTo define the high intraarterial signals on conventional MRI. Methods Review the conventional MRI data in all of the acute ischemic stroke patients in the First Affiliated Hospital,School of Medicine, Zhejiang University from January 2010 to December 2010. ResultsIn year 2010,according to the diagnostic criteria of China, there were 280 cases of acute cerebral infarction, all underwent conventional MRI. Twenty six patients (9. 29％ ) showed high intraarterial signals on conventional MRI.There were 14 cases with high signals in the anterior circulation, including 11 cases in the carotid artery, 2 cases in the anterior cerebral artery, and 1 case in the middle cerebral artery combined with the anterior cerebral artery. In the 11 patients with high signals in the carotid artery, MRA confirmed 14 internal carotid arteries stenosis, with 100％ specificity and 78.6％ sensitivity. There were 12 cases with high signals in the posterior circulation, including 5 cases in the vertebral artery, 3 cases in the basilar artery, and 4 cases in the basilar artery with vertebral artery. One patient did not undergo MRA. MRA confirmed 14 arteries with stenosis, with 100％ specificity and 78.5％ sensitivity. ConclusionsIntravascular high signals showed by conventional MR sequences have high clinical specificity, and its vascular lesions are consistent with the results of MRA.

Effects of brain focal ischemia or chronic stress on the hippocampus-dependent learning and memory function / 中华神经科杂志

Objective To compare the intensity of cognitive impairment and the level of pathological lesion in hippocampus induced by ischemia or chronic stress for a more valuable guidance in the treatment of post-stroke cognitive impairment(PSCI).Methods Forty male adult SD rats were divided medially into 4 groups:control,stress,ischemia and ischemia plus stress.Animals in 3 treatment groups were subjected respectively to an operation of modified selective middle cerebral artery occlusion or a procedure of continuous 3-week chronic unpredictable mild stress or a combined program of the two treatments.Morris water maze was employed to assess hippocampus-dependent learning and memory function and the brain-derived neurotrophic factor(BDNF)expression was detected by immunohistochemical staining in CA3 area and the mRNA amplification through semi-quantitative reverse transcription polymerase chain reaction(RT-PCR).Results Both chronic stressors and ischemia could significantly decrease the learning and memory function in rats like the escape latency in the performance of the Morris water maze test compared with the controL The stress group was related preferentially to a more severe deterioration in the learning function but not statistically in the memory loss as compared to ischemia group.The cognitive function decreased more markedly in rats when suffered the chronic unpredictable mild stresses plus ischemia,In comparison to control,ischemia significantly increased BDNF+ cells in hippocampal CA3 area (27.0 ±2.5 vs 20.1 ±2.1),while stress markedly reduced the expression of BDNF(15.2 ± 1.8 vs 20.1 ±2.1).Their combined effects still statistically led to a reduction in BDNF expression(8.2 ± 1.5,F =52.87,P ＜0.05).The same tendency was found in BDNF mRNA expression.Conclusions Stress may preferentially and powerfully influence hippocampus-dependent cognitive function compared with ischemia and the combination of focal ischemia and stress leads to the most impairments in cognition and hippocampal BDNF expression.Data suggest that more attention should be given to the strategies to increase the resistance to psychosocial stressors and decrease the depressed symptoms for a full PSCI recovery.