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@#Objective To examine the risk factors for increased burden of cerebral small vessel diseases （CSVD） in middle-aged and elderly patients with sudden sensorineural hearing loss （SSNHL）. Methods The data were retrospectively collected from middle-aged and elderly patients who were admitted to the hospital due to SSNHL between May 2019 and May 2023. The patients were analyzed for their clinical manifestations，hearing test results，and radiological features. All enrolled patients were assessed for total CSVD burden，and patients with varying degrees of burdens （0，1，2，and ≥3 points） were compared for their differences in the clinical features and hearing features. Ordinal logistic regression was conducted to identify the independent risk factors for increased total CSVD burden in middle-aged and elderly patients with SSNHL. Results A total of 206 patients with SSNHL were enrolled，including 94 males and 112 females，with an average age of（58.70±7.98）years. The numbers of patients with a total CSVD burden of 0、1、2，and ≥3 points were 108（52.4%），54 （26.2%），29（14.0%），and 15 （7.2%），respectively. Univariate analysis showed significant differences between different CSVD burden groups in age，hypertension status，history of drinking，low-density lipoprotein >3.1 mmol/L，and presence of dizziness at the onset of disease（P<0.05）. Logistic regression analysis demonstrated that aging （OR=1.050；95%CI 1.023-1.077），hypertension（OR=1.584；95%CI 1.036-2.422），history of drinking（OR=2.304；95%CI 1.415-3.754），and presence of dizziness at the onset of disease（OR=1.691；95%CI 1.085-2.637）were independent risk factors for increased CSVD burden in SSNHL patients aged 45 years and above. Conclusion Aging，hypertension，history of drinking，and dizziness at the onset of disease are independent risk factors for increased CSVD burden in middle-aged and elderly patients with SSNHL. Clinicians should conduct radiological evaluations on these patients to identify patients with CSVD at an early stage.
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@#Chronic cerebral hypoperfusion (CCH) is a potential important pathological factor leading to cognitive impairment in vascular dementia (VaD). The pathological mechanisms are complex and diverse,with cerebral white matter lesions being the main pathological feature,which is present throughout the entire progression of cognitive impairment caused by CCH. Dysfunction of the blood-brain barrier and neuroinflammatory responses caused by chronic cerebral hypoperfusion are important causes of cerebral white matter lesions. This article discusses the relationship between cerebral white matter lesions and VaD and the improvement of cerebral white matter lesions in VaD to slow down its development and progression,and explores the mechanism and therapeutic methods for VaD,aiming to find therapeutic targets of VaD to prevent its occurrence and improve symptoms.
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Objective To investigate the relationship between cholinergic pathway damage and the executive dysfunction of patients with different degrees of cognitive impairment caused by cerebral white matter lesions(WML). Methods From March,2016 to December,2017,115 patients were recruited,whose characteristics,such as age,gender, education,and history of hypertension,diabetes and stroke were recorded.According to the T2-weighted MRI,80 patients were defined as WML.WML patients were divided into cognitively normal(CN)group(n=41),vascular cognitive impairment of none dementia(VCIND)group(n=21)and vascular dementia(VaD)group(n=18)ac-cording to the result of Montreal Cognitive Assessment(MoCA)and Clinical Dementia Rating(CDR).Other 35 cases without WML and cognitive impairment were as control group.WML under MRI were evaluated with Cho-linergic Pathways Hyperintensities Scale(CHIPS).All the WML patients were assessed with Stroop Color-Word Test,Trail Making Test, Symbol Digital Modalities Test, and Verbal Fluence Test.The correlation between the scores of CHIPS and the executive tests were analysed. Results There was no significant difference in age, gender, level of education, and cardiovascular disease risk factors among four groups(P>0.05),but there were significant differences in scores of MoCA and CHIPS(F>25.781,P<0.001),while the score of MoCA was the least(P<0.01)and the scores of CHIPS were the most in VaD group (P<0.001).The CHIPS scores of left and bilateral hemisphere negatively correlated with all the scores of execu-tive tests(P<0.05),while that of the right hemisphere just correlated with the scores of some executive tests(P<0.05). Conclusion For cognitive impairment after WML,cholinergic pathway damage may relate with the executive function impairment,especially the damage in left cerebral hemisphere.
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BACKGROUND: Endothelial dysfunction is suggested to be one of the pathogenesis of cerebral white matter lesion (cWML). Vascular endothelial growth factor (VEGF) plays a crucial role in angiogenesis and integrity of vascular endothelial cell, and altered expression of VEGF gene induces vascular diseases including cerebrovascular diseases. The objective of this study is to investigate whether single nucleotide polymorphism (SNP) of VEGF gene confers an increased risk of cWML. METHODS: Total 337 study subjects without history of stroke were included. The presence and severity of cWML were measured on fluid-attenuated inversion recovery image. Genotypes of VEGF -2578G>A, -1154G>A, -634G>C and +936C>T were analyzed. RESULTS: Among 337 study subjects, cWML was found in 208 patients (62%), and fifty-eight cases (17%) of them had overt cWML. In univariate analysis, age, female sex and plasma total homocysteine level (tHcyt) were higher in the mild and overt cWML group than no cWML group (p<0.05). The percentage of previous history of hypertension and the value of systolic blood pressure were higher in overt cWML group than no cWML group. In univariate and logistic regression analysis, none of four tested VEGF SNPs was significantly different between control group, mild and overt cWML groups. There was no difference between plasma tHcyt levels and each VEGF SNPs in control group and cWML groups. CONCLUSIONS: In this study, old age, female sex, hypertension and plasma tHcyt were associated with cWML. However, we failed to find an association between cWML and VEGF gene polymorphism, which may indicate that genetic polymorphism of VEGF does not play a direct role in the pathogenesis of cWML.
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Female , Humans , Blood Pressure , Endothelial Cells , Genotype , Homocysteine , Hypertension , Logistic Models , Plasma , Polymorphism, Genetic , Polymorphism, Single Nucleotide , Stroke , Vascular Diseases , Vascular Endothelial Growth Factor AABSTRACT
BACKGROUND: An alpha2-adrenergic receptor (alpha2-AR, ADRA2) mediates induction of hypotension and inhibition of lipolysis and insulin secretion. We evaluated whether single nucleotide polymorphisms (SNPs) of alpha2A (ADRA2A), alpha2B (ADRA2B), and alpha2C (ADRA2C) adrenergic receptors are associated with cerebral white matter lesion (cWML). METHODS: Total 336 study subjects who had no stroke were enrolled in this study. The Indices of cWML include total WML (TWML), periventricular WML (PVWML), and subcortical WML (SCWML) on brain fluid-attenuated inversion recovery (FLAIR) image. Common genetic variants of ADRA2A (1780G>A), ADRA2B (Ins/Del301-303), and ADRA2C (Ins/Del322-325) were examined. RESULTS: Among 336 study subjects, cWML was found in 66 patients (20%). In multivariate analysis, there were no significant effects of all tested ADRA2 polymorphisms on TWML. Significant association of ADRA2A 1780 AA genotype was found in PVWML (OR: 3.368, 95% CIs: 1.280-8.865, adjusted p-value after false discovery rate (FDR) correction=0.014) but not SCWML. CONCLUSION: Although SNPs of three ADRA2 subtypes failed to reach a significance in overall risk for cWML, the ADRA2A 1780G>A polymorphism may be associated with development of PVWML.
Subject(s)
Humans , Brain , Genotype , Hypotension , Insulin , Lipolysis , Multivariate Analysis , Polymorphism, Single Nucleotide , Receptors, Adrenergic , StrokeABSTRACT
Head MRI and CT scans Can frequently find ischemic cerebral white matter lesions in healthy elderly and in patients with atherosclerosis.Ischemic cerebral white matter lesions are regarded as a manifestation of cerebral small vessel lesions.which Can result in symptoms such as cognitive impairment,and predict extraeranial or intracranial ischemic events.This article reviews the recent progress in research on cerebral white matter lesions.their pathogenesis and clirilcal significance.