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Cerebral small vessel disease (CSVD) is an important cause of ischemic stroke and vascular dementia, which brings heavy burden to families and society. The prevention and treatment of CSVD has always been a research hotspot, but its pathogenesis is still not completely clear. This article reviews the pathogenesis of CSVD, including chronic cerebral hypoperfusion, blood-brain barrier dysfunction, vascular endothelial dysfunction, interstitial fluid reflux disorder, inflammatory response, and genetic factors, in order to provide more sufficient theoretical basis for early intervention and treatment of CSVD.
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Cerebral small vessel disease (CSVD) refers to a series of clinical, imaging and pathological syndromes of cerebral arterioles, capillaries, venules, as well as perivascular brain parenchyma caused by various etiologies, and is one of the important causes of vascular cognitive impairment and dementia. The onset of CSVD is insidious, and the early diagnosis mainly depends on imaging examination. This article reviews the effects of different imaging markers of CSVD on cognitive function and their pathophysiological mechanism.
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Thalamus plays an important role in the connection of sensory, motor and cognitive functions between multiple subcortical regions and cerebral cortex. In recent years, the important role of thalamus in cognitive function has attracted more and more attention. This article reviews the related research progress of thalamic infarction and cognitive impairment.
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Objective:To investigate the clinical safety and efficacy of tirofiban in the treatment of hemiplegic stroke warning syndrome.Methods:Patients with hemiplegic stroke warning syndrome admitted to Jining First People's Hospital without receiving intravenous thrombolysis from January 2018 to May 2020 were enrolled retrospectively. Some patients were given tirofiban intravenous infusion for at least 24 h in acute phase, then received oral antiplatelet therapy (tirofiban group); some only received aspirin+ clopidogrel dual antiplatelet therapy (control group). The primary endpoint was muscle strength at the paralytic side and National Institutes of Health Stroke Scale (NIHSS) score at day 7 after onset. The secondary endpoint was the modified Rankin Scale (mRS) score at 3 months after onset, and ≤2 was defined as good clinical outcome. The safety endpoint was the bleeding events during treatment. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results:A total of 30 patients with hemiplegic stroke warning syndrome were enrolled, including 19 (63.3%) in the tirofiban group and 11 (36.7%) in the control group. There was no significant difference in baseline clinical data between the two groups, and no drug-related bleeding complications occurred during treatment. The muscle strength at paralytic side and NIHSS score at day 7 after onset, NIHSS score at discharge and good clinical outcome rate at 3 months in the tirofiban group were significantly better than those in the control group, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that tirofiban was an independent protective factor for good outcome after adjusting the NIHSS score at the beginning of treatment (odds ratio 0.040, 95% confidence interval 0.040-0.449; P=0.009). Conclusions:Tirofiban is safe and effective in the treatment of patients with hemiplegic stroke warning syndrome in acute phase. It can effectively block the progress of the disease, improve the outcome of patients, and will not increase the risk of bleeding.
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Objective To study the association between impaired fasting glucose (IFG) and cognitive impairment in community elderly residents.Methods A total of ≥60 years old 1223 people were divided into normal fasting glucose (NFG) group (n=981) and IFG group (n=242).Their baseline data were recorded,their cognitive function was assessed according to the MMSE score.Results The education level,BMI,serum FBG,TG,LDL-C levels,incidence of hypertension and hyperlipidemia were significantly higher while the serum HDL-C level was significantly lower in IFG group than in NFG group (P＜0.05,P＜0.01).The incidence of cognitive impairment was significantly higher while the score of MMSE,orientation,attention and calculation,immediate recall and language was significantly lower in IFG group than in NFG group (40.50％ vs 21.51％,24.76±5.38 vs 26.60±4.26,9.07±1.81 vs 9.48±1.15,3.39±2.00 vs 3.88±1.81,2.93±0.41 vs 2.98±0.24,6.74±1.51 vs 7.18±1.15,P＜0.01).Age,female sex,LDL-C and IFG were risk factors for cognitive impairment in the elderly (P＜0.01,P＜0.05) while the education level was a protective factor for cognitive impairment in the elderly (P=0.000).Conclusion IFG is an independent risk factor for cognitive impairment in the elderly.Early diagnosis and intervention can improve cognitive function in the elderly.
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Objective To investigate the effect of neurotrophin-3(NT-3)on the proliferation and apoptosis of bone marrow mesenchymal stem cells(BMSCs)in rats and possible mechanisms. Methods The NT-3 overexpression and lentiviral transfection of BMSCs were co-cultured with neuronal cells respectively and then they were divided into overexpression control group,NT-3 transfection group and shRNA-NT-3 transfection group(NT-3 silencing group).MTT assay was used to detect the cell culture for 24 h,48 h and 72 h. Cell cycle and apoptosis were detected by flow cytometry for 48 h. Real-time quantitative PCR was used to detect the expression of C/EBPβmRNA.The expression of C/EBPβprotein was detected by Western blot. Results MTT results showed that the proliferation ability of BMSCs in the NT-3 overexpres-sion group was significantly higher than that in the control group(0.650±0.042,0.826±0.074)at 48 h and 72 h(P<0.05).Compared with the control group(P<0.05),the cell cycle and apoptosis of BMSCs in NT-3 silencing group were significantly decreased at 48 h and 72 h(P<0.05). The results of 48 h cell cycle and apoptosis showed that the percentage of G1 phase in BMSCs was decreased,G2 and S were increased and the apoptosis was decreased. The percentage of G1 phase in G2-S phase and the increase of apoptosis were in-creased in NT-3 silencing group. The results of Western Blot showed that C/EBPβ mRNA and protein levels were significantly up-regulated in BMSCs of NT-3 overexpression group and significantly decreased in NT-3 silencing group(P<0.05).Conclusion NT-3 may promote the expression of C/EBP beta and affect the ex-pression of its downstream target genes,which can inhibit the apoptosis of BMSCs cells.
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Post-stroke cognitive impairment (PSCI) is one of the common complications of stroke,which has a significant impact on the life of patients.Studies have shown that the incidence of PSCI varies from region to region,and is correlated with demographic and vascular risk factors,or is significantly different due to stroke types and characteristics.The specific mechanism of PSCI remains unclear,but early identification of its risk factors is helpful for early intervention.This article reviews the risk factors of PSCI.
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Unruptured intracranial aneurysm (UIA) is an intracranial aneurysm without rupture history or whose wall has not completely broken through by pathological examination.In recent years,studies have found that UIA is closely associated with cognitive impairment.Understanding the relationship between UIA and cognitive impairment and the pathogenesis of cognitive impairment caused by UIA has important significance for clinical diagnosis,efficacy evaluation,and clinical intervention of UIA related cognitive disorders.This article reviews the research progress of the relationship between UIA and cognitive impairment.
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Hypertension is one of the most important diseases that threaten human health, and has become a global problem. In recent years, the prevalence of hypertension in children has increased significantly year by year, and hypertension in children has a trajectory phenomenon, which is easy to cause cognitive damage and other target organ damage. Therefore, it is necessary to be alert and attached to the relationship between hypertension and cognitive impairment in children. This article reviews the epidemiological characteristics, etiology, diagnostic criteria of hypertension and pathophysiological mechanisms of cognitive impairment caused by hypertension in children.
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White matter lesions (WMLs) are a common neuroimaging finding.With the aging of the population and the development of imaging technology,the detection rate of WMLs in the elderly increased gradually.WMLs are closely associated with ischemic stroke.This article reviews the pathophysiological mechanism,imaging evaluation,clinical manifestation of WMLs,and its relationship with ischemic stroke as well as its prevention and treatment.
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As the number and proportion of aging population increase,dementia has posed tremendous challenges to the sustainable social and economic development of many countries in the world.Thus,dementia has been identified as a global public health priority.Clinically,there is currently no cure for dementia.However,in the past decades epidemiological research has suggested that cardiovascular risk factors and psychosocial factors over the life-course could significantly affect the risk of dementia occurrence later in life.Of these factors,smoking,diabetes,and midlife hypertension,obesity,and high cholesterol might contribute to the clinical onset of late-life dementia by causing cerebral macro-and microvascular damage and neurodegeneration,whereas high educational attainments in early life and social engagement,physical and mentally-stimulating activities during adulthoods might help maintain late-life cognitive function by increasing cognitive reserve.Thus,theoretically clinical onset of dementia is likely to be postponed by implementing interventions targeting these factors over the lifespan.In recent years,evidence from research in Europe and North America has emerged that multimodal interventions that consist of intensive control of cardiovascular risk factors,balanced diets,physical activity,and cognitive training may help maintain cognitive function among individuals at risk for dementia.We call that population intervention research against dementia should be strengthened in China.Identifying the intervention programmes against dementia that are effective specifically among Chinese population is of high relevance for developing the national dementia action plan,and thus effectively dealing with the huge challenges by dementia.
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As an imaging manifestation of cerebral small vascular disease,the relationship between enlarged perivascular spaces (EPVS) and cognitive impairment has attracted much attention.Clinical studies have shown that EPVS may be present in the general population and in patients with cognitive impairment caused by neurodegenerative or cerebrovascular diseases.Further studies have showed that EPVS may be an independent risk factor for cognitive impairment.This article reviews the pathogenesis of cognitive impairment in individuals with EPVS.
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Post-stroke aphasia is an acquired language disorder caused by stroke.It impaired the quality of life of patients and brought a heavy burden to family and the society.Unfortunately,the highly variable predictive factors make the prognosis of aphasia recovery difficult.Much of the researches indicated that the post-stroke aphasia recovery is associated with the patient-related and stroke-related factors.We searched the recent advances on the influence of patient-related factors and stroke-related factors on aphasia recovery.It showed that patient-related factors have no obvious effect on predicting aphasia recovery while the lesion (stroke)-related factors appeared close correlation with post-stroke aphasia recovery.The clinicians should pay more attention on lesion (stroke)-related factors when evaluate the outcome and give the intervention measures.
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Objective To investigate the effectiveness and safety of carotid stenting for progressive cerebral watershed infarction (PCWI) patients with ipsilateral internal carotid stenosis or occlusion during the progressive stage. Methods The clinical data of 23 PCWI patients with ipsilateral internal carotid stenosis or occlusion treated with carotid stenting during the progressive stage were analyzed retrospectively. Among them, 18 were severe internal carotid artery stenosis, and 5 were carotid artery occlusion. Carotid artery stenting were performed in patients with severe internal carotid artery stenosis. The first-stage angioplasty and second-stage stenting were performed in patients with internal carotid artery occlusion. The National Institutes of Health Stroke Scale (NIHSS) score and the modified Rankin scale (mRS) were used to evaluate preoperative and postoperative neurologic deficits. Results Twenty-two of 23 patients were stented successfuly, the Thrombolysis In Myocardial Infarction (TIMI) flow grade was 3, and the technical success rate was 95. 7% . None of the patients demonstrated hyperperfusion in the ipsilateral hemisphere. At day 30 postprocedure, the NHISS scores were significantly improved compared with before procedure (4. 41 ± 1. 88 vs. 10. 00 ± 1. 47; t = 11. 234, P < 0. 001). The preprocedural TIMI flow grade was 3 in 12 patients (52. 2% ). Proportion of patients with TIMI flow grade 3 after procedure was significantly increased compared with before procedure (95. 7% vs. 52. 2% ; χ2 = 11. 274, P = 0. 002). The proportion of patients with mRS scores 0-2 at day 90 after procedure was significantly increased compared with before procedure (69. 6% vs. 0% ; χ2 = 24. 533, P < 0. 001). Conclusions Carotid stenting during the progressive stage is safe and it may improve the prognosis in PCWI patients with ipsilateral internal carotid stenosis or occlusion.
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Objective To investigate the effect of the 5-hydroxytryptamine (5-HT) on the occurrence,development of post-stroke depression (PSD).Methods The literatures on the relationship between 5-HT and PSD were selected from databases such as Wanfang Data,CNKI and PubMed before in 2010-2014.According to absorption and exclusion criteria of the literature,collect literatures,and summary,induce and analyze on them.Results Search 258 literatures and accept 44 literatures accorded with the criteria,including the relationship between 5-HT and PSD,the relationship between 5-hydroxytryptamine receptor (5-HTR) gene polymorphism and PSD,the relationship between 5-hydroxytryptamine transporter linked promoter region (5-HTTLPR) and PSD,and the treatment of selective serotonin reuptake inhibitors (SSRIs) in PSD.Conclusion Reduced levels of 5-HT lead to the occurrence of PSD,and they had a negative correlation;5-HTR 1 A,5-HTR2A are related genes of PSD;S allele and S/S genotype is susceptible factors of PSD,while the L allele is the protective factors of PSD;SSRIs can increase the level of 5-HT in the synaptic gap so as to improve the depressive symptoms of PSD.In the future,it is necessary to increase the sample size to confirm the relationship between 5-HT and PSD,and combine with other factors to explore the relationship between them.
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Objective To study the relationships between retinal microvascular disease and acute coronary event (ACE) among aged people. Methods A controlled study for senile people in communities was conducted. Xinglong Zhuang Coal Mine Community in Jining city, Shandong province was chosen to carry out the study, and the residents in that area aged≥60 years were asked to take questionnaire survey, physical and laboratory examinations. There were 139 cases met the diagnostic criteria of ACE being in the observation group, and 1 509 cases without ACE were assigned in the control group. The gender, age, smoking, alcohol intake, hypertension, diabetes mellitus, education, physical exercise, retinal microvascular disease, fasting blood-glucose, high density lipoprotein cholesterin (HDL-C), low density lipoprotein cholesterin (LDL-C), triacylglycerol (TG), systolic pressure, diastolic pressure, body mass index (BMI) were collected in the two groups to perform univariate analysis. Multivariate non-conditional logistic regression analysis was used for the factors with statistical significance to screen out the independent risk factors that could affect the occurrence of ACE. Results The univariate analysis showed:the risk factors that might cause the occurrence of ACE included age, gender, smoking, hypertension, diabetes mellitus, LDL-C, systolic pressure, diastolic pressure, BMI, and retinal microvascular disease (P<0.05 or P<0.01). In the ACE patients of observation group, the rates of presence of arteriovenous crossing sign [44.6%(62/139) vs. 27.8%(419/1 509)], hard exudates [9.4%(13/139) vs. 4.9%(74/1 509)] and cotton-wool patches [19.4%(27/139) vs. 7.3%(110/1 509)] in retinal microvascular disease were significantly higher than those in control group (P<0.05 or P<0.01). The logistic regression analysis showed:age [P=0.002, odds ratio (OR)=1.06, 95%confidence interval (95%CI)=1.04-1.09], smoking (P=0.032, OR=2.17, 95%CI=2.04-2.30), retinal microvascular disease (P = 0.010, OR = 2.33, 95%CI = 0.97 - 1.27), hypertension (P < 0.001, OR = 5.21, 95%CI=4.11-6.36), diabetes mellitus (P=0.021, OR=1.03, 95%CI=1.01-1.05) and LDL-C (P=0.020, OR=2.80, 95%CI = 2.65 - 2.99) were the independent risk factors for the occurrence of ACE. Conclusions Retinal microvascular disease is the independent risk factor for the occurrence of ACE. The retinal angiography can be a useful examination to forecast ACE.
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Objective To investigate the correhtion between cognitive impairment and cerebral atherosclerosis in patients with acute ischemic stroke.Methods Acute ischemic stroke patients without cognitive impairment were recruited before symptom onset.The Montreal cognitive assessment (MoCA) was used to evaluate the cognitive function.Magnetic resonance imaging (MRI) was used to identify the infarct locations and sides.Magnetic resonance angiography,CT angiography and digital subtraction angiography were used to identify atherosclerotic arteries.Resul~ A total of 101 patients with acute ischemic stroke were enrolled,including 75 (74.3％) with cognitive impairment.The proportions of age (54.54 ± 12.59 years vs.64.43 ± 10.37 years;t =-3.960,P ＜0.001),years of education ≤6 years (50.7％ vs.11.5％;x2 =12.257,P ＜ 0.001),and cerebral atherosclerosis (89.3％ vs.50.0％;x2 =18.137,P ＜0.001) of the cognitive impairment group were significantly higher than those of the normal cognitive function group.Multivariate logistic regression analysis showed that cerebral atherosclerosis was an independent risk factor for cognitive impairment in patients with acute ischemic stroke (odds ratio 1.720,95％ confidence interval 1.005-2.942;P=0.048).MoCA score was negatively correlated with the offending vessels (r=-0.365,P＜ 0.001) and the most severe vessels of atherosclerotic degree (r=-0.243,P =0.014).Conclusions Most patients with acute ischemic stroke had cognitive impairment in the early stage after onset,and the MoCA scores was negatively correlated with the degree of cerebral atherosclerosis.Cerebral atherosclerosis was an independent risk factor for cognitive impairment in patientswith acute ischemic stroke.
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Objective To assess the relationship between ambulatory pulse pressure (PP),pulse pressure indices (PPI) and the severity of cognitive function.Methods Sixty patients with severe,moderate,mild vascular cognitive impairment(VCI) as the research object,and forty healthy people as control group.All of the patients of ambulatory blood pressure were monitored.Results Severe VCI group of PP and PPI was significantly higher than moderate,mild VCI group and the control group (PP (mmHg):(59.10 ± 11.82,54.94 ± 10.86,50.28 ±8.33,45.54±9.22,P＜0.05),PPI:(0.61±0.08,0.53±0.06,0.44±0.05,0.37±0.03,P＜0.05),and the MMSE score was significantly lower than moderate,mild,and the control group(15.56±2.64,19.32±3.32,22.62±3.11,26.45±2.94,P＜0.05).Moderate VCI group of PP and PPI was significantly higher than the control group(P＜0.05).MMSE score was significantly lower than mild VCI and the control group(P＜0.05).Linear correlation analysis showed that PP and PPI was significantly negative related to MMSE score.Conclusion The increase of dynamic pulse pressure,pulse pressure index is associated with the damage of cognitive function.
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Objective To evaluate the safety and efficacy of early carotid artery stenting in treating cerebral watershed infarction patients with carotid artery stenosis. Methods A total of 33 patients with acute cerebral watershed infarction complicated by carotid artery stenosis received carotid artery stenting within one week after the onset of the disease. The clinical safety and efficacy were evaluated. Results The carotid artery stenting was successfully accomplished in all 33 patients with a success rate of 100%. After the procedure, different degree of bradycardia and hypotension was seen in 23 patients, which restored to normal after prompt medication with atropine, dopamine, etc. During the procedure, one patients developed cerebral embolism due to dislodgment of emboli, resulting in contralateral hemiparalysis, and the contralateral limb muscle strength returned to preoperative status after proper treatment. After the treatment, no ipsilateral hemisphere excessive perfusion or cerebral hemorrhage occurred. Thirty days after the treatment, NHISS scores of the patients were obviously improved, which were significantly different from those determined before the treatment (P<0.05). Conclusion For the treatment of acute cerebral watershed infarction, early carotid artery stenting to relieve carotid artery stenosis is quite safe and it may improve the prognosis as well.
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Objective To investigate the characteristics and neural mechanisms of visual attention dysfunction in patients with hypertension using the event related potentials(ERPs).Methods Visual Oddball pattern was adopted to analyze P3a and P3b components of 15 essential hypertensives and 15 normotensives,and all the participants were submitted to cognitive assessment by Mini-Mental State Examination (MMSE).Results ①Novelty stimulus:the mean amplitude of N2 in hypertensive patients ((1.56± 1.15) μV) was decreased than normal controls ((-2.19±1.15) μV,P＜0.05),particularly at forehead-central sites (P＜0.05).In addition,the amplitude of P3a of hypertensive patients ((6.27± 1.01) μV) was different from normal controls ((7.09± 1.01) μV),but there was no statistical significance(P＞0.05).The latency of visual P3a was significantly longer in patients with hypertension group ((432.83 ± 8.22) ms) than that in control group ((403.10 ± 8.22) ms,P＞ 0.05).②Target stimulus:compared with control group ((6.75 ±0.90)μV),visual P3b amplitude in hypertension group ((4.08 ± 0.90) μV) was significantly declined (P＜ 0.05).Besides,the latency of visual P3b of hypertensive patients ((440.70 ± 6.42) ms) was different from normal controls ((436.91±6.42) ms),but there was no statistical significance(P＞0.05).③Compared with control group (27.31± 1.22),the M MSE score of patients with hypertension (24.55±2.42) was decreased (P＜0.05).The amplitude of visual P3b was positively correlated with MMSE scores in parietal region(r=0.51,P＜0.05).Conclusions The abilities of visual involuntary attention and voluntary attention are damaged in patients with hypertension,the impact degree of hypertension on two kinds of attention and the neural mechanisms are different.Moreover,there is a significant positive correlation between the amplitude of visual P3b and MMSE,which prompts that visual P3b for clinical early assessment of attention in patients with hypertension provides more objective neurophysiological basis.