ABSTRACT
Objective:To investigate the efficacy of the Mini-Mental State Scale (MMSE) versus the Montreal Cognitive Assessment Scale (MoCA) in screening cognitive impairment in patients with a lacunar cerebral infarction. Methods:138 eligible patients who received treatment in the Affiliated Hospital of Shanxi Datong University from January 2018 to October 2019 were recruited for this study. They received cognitive function evaluation by the MMSE and MoCA. These patients were grouped according to the median number of age or the median number of years of education. The sensitivity and consistency of the MMSE versus MoCA in screening cognitive impairment in patients with a lacunar cerebral infarction were analyzed using the χ2 test. The total cognitive scores of the MMSE and MoCA, and the scores of each cognitive domain such as memory, execution, visual space, attention, language, and orientation, were compared between groups using multiple linear regression analysis. Results:The sensitivity of MoCA in screening for cognitive impairment in low-age, high-age, low-year-education, and high-year-education groups and the whole population of patients with a lacunar cerebral infarction was 76.5%, 75.7%, 74.2%, 77.8%, 76.1%, respectively, which were significantly higher than those of MMSE (44.1%, 65.7%, 60.6%, 50.0%, 55.1%, χ2 = 12.17, 13.13, 9.33, 15.75, 23.86, all P < 0.01). The Kappa coefficients of low-age, high-age, low-year-education and high-year-education groups were 0.336, 0.391, 0.358, 0.389, and 0.373, respectively, all of which were less than 0.4 (all P < 0.01). These findings suggest that the consistency of the two scales in screening cognitive impairment is poor. The cognitive impairment detection rate by the MMSE was significantly higher in the high-age group than in the low-age group (65.7% vs. 44.1%, χ2 = 6.50, P < 0.05). The total cognitive scores of MMSE and MoCA and the scores of memory, execution, visual space, attention, language, and orientation in patients with a lacunar cerebral infarction were significantly lower in the high-age group or low-year-education group than in the low-age group ( tMMSE = 3.61, 2.49, 3.12, 4.26, 1.70, 3.69, 2.24, all P < 0.01; tMoCA = 3.83, 1.75, 3.28, 3.80, 2.21, 4.08, 2.52, all P < 0.05) or high-year-education group ( tMMSE = -2.87, -2.32, -0.85, -2.54, -0.73, -2.57, -2.96, all P < 0.01; tMoCA = -2.95, -1.12, -3.39, -1.54, -1.52, -3.09, -3.02, all P < 0.05). Conclusion:Combined application of MMSE and MoCA has a high clinical value in screening cognitive impairment in patients with a lacunar cerebral infarction. High-age patients with a lacunar cerebral infarction who receive low-year education have memory, execution, visual space, attention, language, and orientation impairments.
ABSTRACT
Objective To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) on admission for early neurological deterioration (END) in patients with lacunar stroke.Methods Patients with acute lacunar stroke admitted to the Department of Neurology,the Second People's Hospital of Lianyungang from June 2015 to October 2017 were enrolled retrospectively.END was defined as an increase of ≥2 in the National Institutes of Health Stroke Scale (NIHSS) score within 72 h of admission.Multivariate logistic regression analysis was used to determine the independent risk factors for END.The receiver operating characteristic (ROC) curve was used to analyze the predictive value of NLR for END in patients with lacunar stroke.Results A total of 309 patients with acute lacunar infarction were enrolled,including 180 males (58.2％),aged 59.7 ±7.3 years;65 patients (21.0％) in END group and 244 (79.0％) in non-END group.Multivariate logistic regression analysis showed that after adjusting for other confounders,NLR was an independent risk factor for END in lacunar stroke (odds ratio 4.508,95％ confidence interval 3.128-7.547;P＜0.001).ROC curve analysis showed that the area under the curve of NLR predicting END in patients with lacunar stroke was 0.725 (95％ confidence interval 0.671-0.776;P ＜ 0.001);the optimal cut-off value was 2.32,the sensitivity of predicting END was 61.21％,and the specificity was 72.54％.Conclusion The elevated NLR after admission is an independent risk factor for END in patients with lacunar stroke,which has certain value for early identification and prediction of END.
ABSTRACT
Objective@#To investigate the effects of metabolic syndrome (MetS) and each component on cerebral artery stenosis in patients with subcortical ischemic vascular disease (SIVD).@*Methods@#From June 2017 to May 2019, patients with SIVD admitted to the Departments of Neurology, the First and Forth Affiliated Hospitals of Anhui Medical University were enrolled retrospectively. MetS was diagnosied using NCEP-ATP III criteria. The North American Symptomatic Carotid Endarterectomy Trial criteria were used to evaluate the degree of cerebral artery stenosis. Multivariate logistic regression analysis was used to determine the independent correlation between MetS and cerebral artery stenosis.@*Results@#A total of 460 patients with SIVD were enrolled, including 289 males (62.8%), 171 females (37.2%), and age 72.7±4.787 years; 278 (60.4%) in the MetS group, 182 (39.6%) in the non-MetS group; and 279 (60.7%) in the cerebral artery stenosis group, 181 (39.3%) in the non-stenotic group. The proportion of patients with cerebral artery stenosis in the MetS group was significantly higher than that in the non-MetS group (84.2% vs. 24.7%; χ2=162.876, P<0.001). Among them, the proportions of patients with middle cerebral artery, internal carotid artery, vertebral artery, basal artery, and multiple cerebral artery stenosis in the MetS group were significantly higher than those in the non-MetS group (all P<0.05), and the proportion of patients with moderate and severe cerebral arterial stenosis was also significantly higher than that in the non-MetS group (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for confounding factors such as previous stroke or transient ischemic attack history, alcohol consumption, and low-density lipoprotein cholesterol levels, there was still a significant independent correlation between the number of MetS components and cerebral arterial stenosis; with the number of MetS components increaseing, especially 3 or more, the risk of cerebral artery stenosis increased (2 components: odds ratio [OR] 4.573, 95% confidence interval [CI] 1.388-15.068; 3 components: OR 452.450, 95% CI 115.505-1 772.310; 4 components: OR 452.503, 95% CI 117.664-1 740.191; 5 components: OR 411.356, 95% CI 96.975-1 744.911).@*Conclusions@#MetS is an independent risk factor for cerebral artery stenosis in patients with SIVD, and the correlation between them increases with the increase of MetS components.
ABSTRACT
Objective@#To investigate the correlation between β-fibrinogen (FGB) gene -455G/A polymorphism and plasma fibrinogen (Fg) level and lacunar infarction (LI).@*Methods@#From June 2018 to August 2019, consecutive subjects without cerebrovascular disease and dementia admitted to the Department of Neurology, the People's Hospital of Liaoning Province were enrolled prospectively. According to whether there was LI or white matter hyperintensities (WMHs) in brain MRI, the patients were divided into LI group, LI+ WMHs group and control group. Polymerase chain reaction and gene sequencing technology were used to detect FGB -455G/A polymorphism. The turbidimetry was used to measure plasma Fg level. Multivariate logistic regression analysis was used to determine the independent risk factors for LI and LI+ WMHs.@*Results@#A total of 202 subjects were included, including 48 in the LI group, 58 in the LI+ WMHs group, and 96 in the control group. The proportions of patients with hypertension, dyslipidemia, and hyperhomocysteinemia and plasma Fg levels in the LI and LI+ WMHs groups were significantly higher than those in the control group (all P<0.05). There was no statistical difference in FGB -455G/A genotype and allele frequency between the three groups. The plasma Fg level of AG+ AA genotype was significantly higher than that of GG genotype (P<0.001), and there was no significant difference in demography and other vascular risk factors. Regardless of the genotype, the plasma Fg level was highest in the LI+ WMHs group, followed by the LI group and the control group, and the differences between each pair were statistically significant (P<0.05). Multivariate logistic regression analysis showed that hypertension (odds ratio [OR] 2.289, 95% confidence interval [CI] 1.015-5.166, P=0.046; OR 2.457, 95% CI 1.021-5.913, P=0.045), dyslipidemia (OR 2.681, 95% CI 1.217-5.905, P=0.014; OR 3.061, 95% CI 1.296-7.233, P=0.011) and plasma Fg levels (OR 5.038, 95% CI 2.328-10.902, P<0.001; OR 20.198, 95% CI 8.143-50.097, P<0.001) were all the independent risk factors for LI and LI+ WMHs.@*Conclusions@#The increased plasma Fg level, dyslipidemia, and hypertension were the independent risk factors for LI and LI+ WMHs. Although FGB -455G/A polymorphism could affect plasma Fg level, it had no significant correlation with LI and LI+ WMHs.
ABSTRACT
Cerebral small vessel disease (CSVD) is a common group of neurological conditions that confer a significant burden of morbidity and mortality worldwide. In most cases, CSVD is only recognized in its advanced stages once its symptomatic sequelae develop. However, its significance in asymptomatic healthy populations remains poorly defined. In population-based studies of presumed healthy elderly individuals, CSVD neuroimaging markers including white matter hyperintensities, lacunes, cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and cerebral microinfarcts are frequently detected. While the presence of these imaging markers may reflect unique mechanisms at play, there are likely shared pathways underlying CSVD. Herein, we aim to assess the etiology and significance of these individual biomarkers by focusing in asymptomatic populations at an epidemiological level. By primarily examining population-based studies, we explore the risk factors that are involved in the formation and progression of these biomarkers. Through a critical semi-systematic review, we aim to characterize “asymptomatic” CSVD, review screening modalities, and draw associations from observational studies in clinical populations. Lastly, we highlight areas of research (including therapeutic approaches) in which further investigation is needed to better understand asymptomatic CSVD.
Subject(s)
Aged , Humans , Biomarkers , Cerebral Small Vessel Diseases , Epidemiology , Leukoaraiosis , Mass Screening , Mortality , Neuroimaging , Risk Factors , Siderosis , Stroke, Lacunar , White MatterABSTRACT
Lacunar stroke is one of the most common ischemic stroke types in clinical practice at present. Its prognosis is generally better. However, studies have shown that about 20％ ～30％ of patients with lacunar stroke may have early neurological deterioration. This article reviews the pathophysiological mechanisms and predictors of early neurological deterioration in patients with lacunar stroke.
ABSTRACT
Intracerebral hemorrhage (ICH) and lacunar infarction (LI) are the major acute clinical manifestations of cerebral small vessel diseases (cSVDs). Hypertensive small vessel disease, cerebral amyloid angiopathy, and hereditary causes, such as Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), constitute the three common cSVD categories. Diagnosing the underlying vascular pathology in these patients is important because the risk and types of recurrent strokes show significant differences. Recent advances in our understanding of the cSVD-related radiological markers have improved our ability to stratify ICH risk in individual patients, which helps guide antithrombotic decisions. There are general good-practice measures for stroke prevention in patients with cSVD, such as optimal blood pressure and glycemic control, while individualized measures tailored for particular patients are often needed. Antithrombotic combinations and anticoagulants should be avoided in cSVD treatment, as they increase the risk of potentially fatal ICH without necessarily lowering LI risk in these patients. Even when indicated for a concurrent pathology, such as nonvalvular atrial fibrillation, nonpharmacological approaches should be considered in the presence of cSVD. More data are emerging regarding the presentation, clinical course, and diagnostic markers of hereditary cSVD, allowing accurate diagnosis, and therefore, guiding management of symptomatic patients. When suspicion for asymptomatic hereditary cSVD exists, the pros and cons of prescribing genetic testing should be discussed in detail in the absence of any curative treatment. Recent data regarding diagnosis, risk stratification, and specific preventive approaches for both sporadic and hereditary cSVDs are discussed in this review article.
Subject(s)
Humans , Anticoagulants , Atrial Fibrillation , Blood Pressure , CADASIL , Cerebral Amyloid Angiopathy , Cerebral Hemorrhage , Cerebral Small Vessel Diseases , Diagnosis , Genetic Testing , Pathology , Stroke , Stroke, LacunarABSTRACT
Cerebral small vessel disease is a common cerebrovascular disease in clinical practice.It is mainly characterized by insidious onset and slow development.Some may have acute attack.The imaging features of cerebral small vessel disease mainly include cerebral white matter lesions,lacunar infarction,cerebral microbleed and cerebral perivascular space expansion.It is closely associated with cognitive impairment.All imaging findings can occur simultaneously and interact,further aggravate cognitive impairment,and ultimately lead to dementia.Therefore,the influence of cerebral small vessel disease on the quality of life and social function of the patients cannot be ignored.
ABSTRACT
Cerebral smal vessel disease (CSVD) can be divided into sporadic and hereditary CSVD. The exact pathogenesis of sporadic CSVD is unknow n. Genetic factors may also play an important role, except for environmental and vascular risk factors. As a complicated disease, sporadic CSVD has the characteristics of multigenetic susceptibility. Therefore, investigating the related genetic factors may contribute to understanding the pathogenesis of sporadic CSVD. This article review s the advances in research on the genetics of sporadic CSVD.
ABSTRACT
ObjectiveToinvestigatethecharacteristicsofsinglelacunarinfarct(SLI)andipsilateral multiple lacunar infarction (MLI), and the differences of risk factors and and pathologies betw een them. Methods The clinical data of al patients w ith cerebral infarction in acute internal carotid artery territory from August 1, 2008 to December 13, 2014 w ere analyzed retrospectively. Lacunar infarctions w ere screened according to the clinical manifestations and imaging findings. The patients w ere divided into a SLI, a unilateral MLI in the same blood supply area (MLI 1) and a unilateral MLI in the different blood supply area (MLI 2) group according to the number and location of the lesions show ed on diffusion w eighted imaging. Multivariate logistic regression analysis w as used to identify potential independent risk factors. Results The incidences of ipsilateral carotid plaque (73.33%vs.48.67%; χ2 =5.801, P=0.016), ipsilateral unstable carotid plaque ( 70.0%vs.42.5%; χ2 =7.192, P= 0.007 ), and ipsilateral carotid stenosis ≥50%(16.67%vs.1.77%; χ2 =8.327, P=0.004) of the MLI 1 group w ere significantly higher than those of the SLI group; the incidence of atrial fibril ation of the MLI 2 group w as significantly higher than that of the SLI group (40.0%vs.0.88%; χ2=15.887, P<0.001); there w ere no significant differences in the remaining risk factors among each group. Multivariate logistic regression analysis showed that atrial fibrilation (odds ratio [OR] 14.452, 95% confidence interval [CI] 1.558-134.011; P=0.019) and ipsilateral carotid stenosis ≥50% (OR 11.483, 95%CI 2.202-59.891; P=0.011) w ere the independent risk factors for MLI. Conclusions MLI may have different risk factors and pathogeneses w ith SLI. Atherosclerotic lesions and embolism are the important pathogeneses of MLI, w hile SLI is not.
ABSTRACT
Objective To investigate the correlation between the indicators of common carotid artery mechanical dynamics, a circumferential wal tension (CWT) and a shear stress (SS), and cerebral smal vessel disease (SVD). Methods The neurological outpatients without obvious cardiovascular disease were enrol ed consecutively. The inner diameters of carotid arteries and blood flow velocity of the patients w ere measured by ultrasound examination, and their CWT and SS w ere calculated. Lacunar infarction and/or leukoaraiosis w ere determined according to the findings of MRI. Results A total of 296 patients w ere enrol ed, 163 of them had lacunar infarction and 132 had leukoaraiosis. Univariate analysis show ed that there w ere significant differences in the distributions of age, hypertension, diabetes, systolic blood pressure, diastolic blood pressure, CWT, and SS betw een the lacunar infarction group and the non-lacunar infarction group, as wel as between the leukoaraiosis group and the non-leukoaraiosis group (al P<0.05). After adjusting for relevant risk factors, multivariate logistic regression analysis show ed that the peak systolic CWT (odds ratio [OR] 3.60, 95% confidence interval [CI] 1.48-8.30) and end diastolic CWT (OR 1.22, 95%CI 1.21-1.25) w ere the independent risk factors for lacunar infarction, w hile the peak systolic SS (OR 0.90, 95%CI 0.75-0.95 ) and end diastolic SS ( OR 0.87, 95%CI 0.84-0.98 ) w ere the independent protective factors for lacunar infarction; the peak systolic CWT (OR 4.67, 95%CI 2.05-10.52) and end diastolic CWT (OR 1.25, 95%CI 1.22-1.47) were the independent risk factors for leukoariosis, w hile the peak systolic SS (OR 0.93, 95%CI 0.75-0.94) and end diastolic SS (OR 0.91, 95%CI 0.85-0.98) w ere the independent protective factors for leukoaraiosis. Conclusions The common carotid artery mechanical stress w as associated w ith the occurrence of SVD.
ABSTRACT
Objective To detect the distribution of cerebral microbleeds (CMBs) in patients with lacunar infarction (LI) and/or leukoaraiosis (LA) and to analyze the correlation between the CMB related risk factors and cognitive impairment.Methods Thirty-eight patients with LI and/or LA were divided into either a CMB group or a non-CMB group according to the findings of susceptibility weighted imaging.The number of CMB lesions was recorded.Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were used to conduct cognitive function tests,and the patients were also divided into a cognitive impairment group and a non-cognitive impairment group according to the MoCA scores.The demographic and clinical data in each group were compared.The independent risk factors for CMBs and cognitive impairment were identified.Results Thirteen patients had 58 CMBs in the CMB group.Their distributions were as follows:36 CMBs in basal ganglia and thalamus,14 in cortical and subcortical regions,3 in brain stem,and 5 in cerebellum.There were 25 patients in the non-CBM group,26 in the cognitive impairment group,and 12 in the non-cognitive impairment group.There were significant differences in age and the proportions of hypertension,taking antithrombotic drugs and the patients with LA between the CMB group and the non-CMB group (all P ＜ 0.05).Multivariable logistic regression analysis showed that only age was an independent risk factor for CMBs (odds ratio 1.103,95％ confidence interval 1.034-1.454; P =0.045).MMSE (26.92±2.87vs.29.00± 1.44; t=2.452,P=0.027) and MoCA (21.62±3.36vs.25.04 ± 2.59; t =-3.493,P =0.001) scores in the CMB group were significantly lower than those in the non-CMB group.There was only significant difference in the number of CMBs between the cognitive impairment group and the non-cognitive impairment group (2.08-± 3.64 vs.0.33 ±0.78; t =-1.629,P =0.010).Multivariate logistic regression analysis showed that only the number of CMBs was an independent risk factor for cognitive impairment (odds ratio,1.534,95％ confidence interval 1.100-2.576; P=0.046).Spearman rank correlation analysis showed that the number of CMBs was significantly negatively correlated with the MoCA language (r =-0.229,P=0.003) and the delayed recall (r =-0.332,P=0.042) scores.Conclusions In patients with LI and/or LA,CMBs were correlated with age.Their existence and number were associated with cognitive impairment.
ABSTRACT
Intracranial branch atheromatous disease (BAD) was proposed by Caplan in 1989.It has been widely studied in Japan in recent years.With the application of high-resolution magnetic resonance,BAD has become a hot topic.This article reviews the concept,etiology,pathology,diagnosis and treatment of BAD as well as its relationship with ischemic stroke.
ABSTRACT
Objective To investigate the features and its risk factors for cognitive impairment in patients with lacunar infarct (LI) and white matter lesion (WML).Methods The inpatients with LI and WML aged 65 to 75 years old were enrolled.Their demographic and clinical data were collected.LI and WML were diagnosed by magnetic resonance imaging (MRI).Montreal Cognitive Assessment Scale (MoCA) was used to evaluate cognitive function.Self-Rating Depression Scale and Hamilton Anxiety Scale were used to exclude patients with depression and anxiety.The patients were divided into either a cognitive impairment group or a normal cognitive function group.The demographic and clinical data of both groups were compared.Multivariate logistic regression analysis was used to analyze and determine the independent risk factors for cognitive impairment.The characteristics of cognitive impairment of LI and WML were compared.Results A total of 130 patients with LI or WML were enrolled,92 of them had cognitive impairment,and 38 had normal cognitive function; 85 had LI,and 45 had WML; 53 were males and 77 were females.Univariate analysis showed that years of education in the cognitive impairment group (7.54 ±4.65 years vs.11.29 ±3.17 years; t =4.286,P=0.001) was significantly lower than that of the normal cognitive function group,while the constituent ratios of hypertension (54.6％ vs.16.2％ ;x2 =4.477,P =0.018),hyperlipidemia (53.1％ vs.16.2％ ;x2 =5.263; P =0.044),diabetes mellitus (46.9％ vs.10.8％;x2 =3.827,P=0.017),as well as LI (43.8％ vs.21.5％;x2 =3.928,P=0.015) and WML (26.9％ vs.7.7％ ;x2 =4.072,P =0.009) were significantly higher than those of the normal cognitive function group.Multivariate logistic regression analysis showed that years of education (odds ratio [OR],1.305,95％confidence interval [CI] 1.104-7.975; P =0.001),diabetes mellitus (OR 1.328,95％ CI 1.292-3.422;P =0.015),hypertension (OR 1.978,95％ CI 1.034-5.443; P =0.028,LI (OR 1.224,95％ CI 1.004-2.007; P =0.013),and WML (OR 1.489,95％ CI 1.202-3.778; P =0.010) were the independent risk factors for cognitive impairment.The total MoCA score (21.61 ± 5.33 vs.19.19 ± 7.07; t =1.841,P =0.038) and cube copy (0.43 ± 0.50 vs.0.31 ± 0.47; t =1.104,P =0.010),clock drawing test (2.53 ±0.89 vs.2.04 ± 1.22; t =2.229,P =0.008),letters identification (0.85 ±0.36 vs.0.62 ±0.50; t =2.585,P==0.000),and 100 minus 7 consecutively (2.62 ±0.79 vs.2.19 ± 1.17; t =2.113; P=0.001) of the WML group were significantly lower than those of the LI group.Conclusions The patients with LI and WML often had cognitive impairment,and the cognitive impairment in patients with WML was more serious.Years of education,hypertension and diabetes were the independent risk factors for cognitive impairment in patients with LI and WML.Visuospatial executive function and attention damage in patients with WML were severer than those of the patients with LI.
ABSTRACT
Objective To investigate the difference of expression profiling of plasma miRNAs (microRNA) between the patients with small artery occlusive stroke (SAO) and the healthy subjects.Methods Eight patients with SAO classified by TOAST were selected and 8 healthy subjects were used as a control group.High-throughput sequencing technology was used to detect the expression profiling of plasma miRNAs.The differentially expressed miRNAs were screened.Real-time fluorescent quantitative polymerase chain reaction was used to validate the results,and the target gene prediction and bioinformatics analysis were performed.Results The miRNA difference analysis showed that the expression profilings of miRNA-127,miRNA-99b-5p,miRNA-320,and other 19 miRNAs in the SAO group were significantly upregulated compared with those in the control group (all P＜0.01),while miRNA-451a and other 5 miRNAs in the SAO group were significantly downregulated compared with those in the control group (all P ＜0.01).The validated results of miRNA-127,miRNA-99b-5p,miRNA-320,and miRNA-451a with real-time fluorescent quantitative polymerase chain reaction were consistent with those of the high-throughput sequencing.Bioinformatics analysis showed that the miRNA-regulated target genes expressed differentially were mainly correlated with cell proliferation,adhesion,phylogenetic development,macromolecule metabolism,and other biological functions.Conclusions There are significant differences in the expression profiling of plasma miRNAs between the patients with SAO and the healthy subjects,suggesting that miRNAs may play a regulatory role via target genes in pathogenesis of SAO.
ABSTRACT
Cerebral small vessel disease refers to the diseases that affects intracranial small arteries,arterioles,precapillaries,and venules.The image-based types mainly include white matter lesion,lacunar infarction,and cerebral microbleeds.It is believed to be the independent risk factors of cognitive impairment or vascular dementia.The location,number and volume of the small vessel diseases may all influence the degree of cognitive impairment and manifestation.
ABSTRACT
Capsular warning syndrome (CWS) is a subtype of recurrent stereotyped transient ischemic attacks that heralds a subsequent stroke.The mainly presumed mechanism is repeated bursts of ischemia in the region of penetrating arteries,since the structural changes of large arteries is rare in series of imaging examinations.The majority of the infarct is located in the internal capsule or pontine.CWS is usually therapeutically resistant to simple traditional antithrombotic treatment,while combined antiplatelet treatment,thrombolysis,endovascular intervention and antiepileptics may protect part of the patients from developing into permanent infarcts.