Cognitive function changes and their influential factors in patients with ischemic stroke and leukoaraiosis / 中国基层医药

Objective:To investigate cognitive function changes and their influential factors in patients with ischemic stroke and leukoaraiosis.Methods:A total of 500 patients with ischemic stroke who received treatment in Yiwu Central Hospital from January 2018 to October 2019 were included in this study. They were divided into simple ischemic stroke group ( n = 200) and ischemic stroke complicated by leukoaraiosis group (combination group, n = 300). The infarct location and the degree of leukoaraiosis in the combination group were analyzed. An additional 150 volunteers who concurrently underwent the Cognitive Function Test in the same hospital were selected as controls. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Patients in the combination group were divided into cognitive impairment group (MoCA score ≥ 26 points) and non-cognitive impairment group (MoCA score < 26 points) according to MoCA score. The risk factors of cognitive impairment in patients with ischemic stroke and leukoaraiosis were analyzed. Results:The scores of the MMSE, MoCA, Clock Drawing Test (CDT), Verbal Fluency Test (VFT), and Digit Span Test (DST) in the control group were (28.93 ± 2.70) points, (28.35 ± 2.74) points, (4.69 ± 1.14) points, (4.94 ± 0.42) points, and (14.33 ± 1.66) points respectively. They were (26.92 ± 2.18) points, (25.02 ± 3.52) points, (3.61 ± 1.60) points, (4.77 ± 0.46) points, and (11.73 ± 1.16) points, respectively in the simple ischemic stroke group and (24.91 ± 2.79) points, (20.70 ± 3.06) points, (2.87 ± 1.23) points, (4.07 ± 0.85) points, and (10.82 ± 0.93) points respectively in the combination group. There were significant differences in the scores of the MMSE, MoCA, CDT, VFT, and DST among the three groups ( F = 124.50, 318.50, 93.43, 112.60, 428.60, all P < 0.001). Significant differences in the scores of the MMSE, MoCA, CDT, VFT, and DST were observed between patients with different degrees of leukoaraiosis ( F = 69.09, 102.40, 20.98, 60.90, 57.00, all P < 0.001). Spearman correlation analysis results showed that the scores of the MMSE, MoCA, CDT, VFT, and DST were negatively correlated with the degree of leukoaraiosis ( r = -0.61, -0.69, -0.43, -0.56, -0.44, all P < 0.05). Logistic regression analysis results showed that age, history of smoking and drinking, history of diabetes, history of stroke, and infarct location were the independent risk factors for cognitive impairment in patients with ischemic stroke and leukoaraiosis. Education level was a protective factor against ischemic stroke and leukoaraiosis. Conclusion:The degree of cognitive impairment in patients with ischemic stroke and leukoaraiosis is related to the degree of leukoaraiosis. Age, history of smoking and drinking, history of diabetes, history of stroke, infarction location, and education level are the influential factors of cognitive impairment.

Correlation between lesion volume ratio and cognitive function in ischemic leukoaraiosis / 中国医师进修杂志

Objective:To investigate the relationship between the volume ratio of ischemic leukoaraiosis (LA) and cognitive level and arterial perfusion.Methods:Fifty-four patients, who was hospitalized in Dalian Central Hospital and diagnosed as LA clinically during the time of March to December in 2012, were selected to collect the information of the volume ratio of white matter disease, MoCa score and the average flow rate of carotid artery. The correlation between the volume ratio of white matter disease and MoCa score, cognitive impairment and the average flow rate of carotid artery were analyzed.Results:The volume ratio of LA lesions was negatively correlated with MOCA score ( r = -0.59, P<0.01); the volume ratio of LA lesions was negatively correlated with the mean flow rate of internal carotid artery ( r = -0.37, P<0.01). Quantity order of the area under receiver operating characteristic (ROC) curve of MoCA cognitive subgroup was as following: delayed memory (1.000)> visual space/executive function (0.970) = abstract force (0.970)> language ability (0.960)> attention (0.888). Conclusions:The larger the volume ratio of leukopathy in LA patients, the more serious the cognitive impairment, especially the cognitive impairment of impairment of memory delay, visual space/executive function, abstract ability and language ability.

White matter hyperintensities: repercussion on grey matter structures of the brain / Hiperintensidades da substância branca: repercussão em estruturas da substância cinzenta do cérebro

The extensive white matter of the brain, which comprises about one half of its volume, is constituted by an intricate and interwoven assemble of nerve fibers. The WMH (leukoaraiosis) represent the most frequent ischemic type of lesion of SVD, affecting the white matter. These lesions may be apparent or normal appearing on neuroimaging. In both cases such lesions may interrupt the affected white matter fibers, with consequent disconnection syndromes, and atrophy of the denervated grey matter structures. These conditions affect the structural neural networks (connectome), with functional repercussion on the cognitive and behavioral domains.

A extensa substância branca do cérebro, que compreende cerca da metade do seu volume, é constituída por um intricado e entrelaçado conjunto de fibras nervosas. As HSB (hiperintensidades da substância branca) (leucoaraiose) representam o mais frequente tipo de lesão isquêmica da DPV (doença dos pequenos vasos) que afeta a substância branca. Essas lesões podem ser aparentes ou de aparência normal na neuroimagem. Em ambos os casos tais lesões podem interromper essas fibras da substância branca, com consequente síndromes por desconexão e atrofia de estruturas de substância cinzenta desnervadas. Essas condições afetam as redes neurais estruturais (conectoma), com repercussão funcional nos domínios cognitivo e do comportamento.

Claudin-1 and Claudin-3 as Molecular Regulators of Myelination in Leukoaraiosis Patients

OBJECTIVES: Leukoaraiosis is described as white matter lesions that are associated with cognitive dysfunction, neurodegenerative disorders, etc. Myelin depletion is a salient pathological feature of, and the loss of oligodendrocytes is one of the most robust alterations evident in, white matter degeneration. Recent studies have revealed that claudin proteins are aberrantly expressed in leukoaraiosis and regulate oligodendrocyte activity. However, the roles of claudin-1 and claudin-3 in oligodendrocytes and leukoaraiosis are still not well-defined. METHODS: Quantitative polymerase chain reaction was used to measure the expression of claudin-1 (CLDN1), claudin-3 (CLDN3), and myelinogenesis-related genes such as myelin basic protein (MBP), proteolipid protein (PLP), oligodendrocyte transcription factor 2 (OLIG2), and SRY-box transcription factor 10 (SOX10) in leukoaraiosis patients (n=122) and healthy controls (n=122). The expression of claudin-1 and claudin-3 was either ectopically silenced or augmented in Oli-neu oligodendrocytes, and colony formation, apoptosis, and migration assays were performed. Finally, the expression of myelin proteins was evaluated by western blotting. RESULTS: Our results revealed that in addition to SOX10, the expression levels of claudin-1, claudin-3, and myelinogenesis-related proteins were prominently downregulated in leukoaraiosis patients, compared to those in healthy controls. Furthermore, the growth and migration of Oli-neu cells were downregulated upon silencing claudin-1 or claudin-3. However, the overexpression of claudin-1 or claudin-3 resulted in the reduction of the degree of apoptosis in Oli-neu cells. In addition, claudin-1 and claudin-3 promoted the expression of MBP, OLIG2, PLP, and SOX10 at the translational level. CONCLUSION: Our data has demonstrated that the abnormal expression of claudin-1 and claudin-3 regulates the pathological progression of leukoaraiosis by governing the viability and myelination of oligodendrocytes. These findings provide novel insights into the regulatory mechanisms underlying the roles of claudin-1 and claudin-3 in leukoaraiosis.

Correlation between metabolic syndrome and cerebral artery stenosis in patients with subcortical ischemic vascular disease / 国际脑血管病杂志

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.

Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies / 대한뇌졸중학회지

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.

Resting-state Neural Networks and Granger Causal Connectivity for Patients with Cognitive Impairment Associated with Leukoaraiosis / 中国康复理论与实践

Objective:To compare the difference in resting state networks among leukoaraiosis (LA) patients with or without mild cognitive impairment, and healthy controls, as well as the functional connectivity under Granger causality analysis (GCA). Methods:Subjects aged 40 to 80 years, including 34 LA-MCI patients, 15 LA patients with normal cognition and 33 healthy controls, accepted resting-state functional magnetic resonance imaging. Independent component analysis was used to separate functional brain networks, and difference of activation was determined with two sample t-test. GCA was used to analyze effective connectivity of these functional networks. Results:Eight resting state networks were obtained, including default mode network, motor network, medial visual network, lateral visual network, right-memory network, left-memory network, auditory network and executive network. Activation was different among three groups. Effective connectivity of RSNs was also different among three groups. Conclusion:Components of the resting state networks keep changing as LA progressing. Activation decreases as patients' cognition impaired. The direction and strength of connections remodel.

Relationship between 24 h ambulatory blood pressure and severity of white matter hyperintensities / 国际脑血管病杂志

Objective To investigate the correlation between 24 h ambulatory blood pressure monitoring (ABPM) parameters and white matter hyperintensities (WMHs).Methods A cross-sectional analysis was performed in patients who visited the Department of Neurology,Liaoning People's Hospital,and showed WMHs on the head MRI and completed 24 h ABPM in the same period of hospitalization from September 2016 to October 2018.Periventricular white matter hyperintensities (PVWMHs) and deep white matter hyperintensities (DWMHs) were evaluated using the modified Scheltens scale respectively,and the sum of the two was used as the overall severity score of WMHs.The enrolled patients were grouped according to the tertiles of the overall WMH score.Multivariate ordinal logistic regression analysis was used to investigate independent risk factors affecting overall WMH scores.Multivariate linear regression analysis was used to investigate the influencing factors of PVWMH and DWMH scores.Results A total of 201 patients were enrolled,aged (62.7 ± 10.3) years (range 45-88 years),82 males (40.8％),and 123 patients (61.2％) with hypertension.The total WMH scores were 1-27.According to the tertiles,64 patients (31.8％) were divided into lower tertile group (1-3),65 (32.3％) in the middle tertile group (4-8),and 72 (35.8％) in the higher tertile group (9-27).There was significant difference in age between any two WMH score groups,namely,the high tertile group ＞ middle tertile group ＞ low tertile group (69.5 ± 8.5 years vs.63.1 ±9.2 years vs.54.5 ±6.9 years;all P＜0.001).The proportion of hypertension in the middle tertile group (66.2％) and the higher tertile group (69.4％) were significantly higher than those in the lower tertile group (46.9％;all P＜0.05).The homocysteine in the higher tertile group was significantly higher than that in the lower tertile group (15.6 [12.7-19.7]μmol/Lvs.14.1[12.5-15.9]μmol/L;P ＜0.05).In terms of 24 h ABPM parameters,the 24 h mean systolic blood pressure (24 h SBP) in the higher tertile group was higher than that in the lower tertile group,and the nighttime mean systolic blood pressure (nSBP) level in the higher tertile group was higher than that in the lower and middle tertile groups,the SD of daytime systolic blood pressure (dSBPSD) and the SD of the nighttime systolic blood pressure (nSBPSD) in the higher tertile group were higher than those in the lower tertile group,and dSBPSD of the middle tertile group was higher than of the lower tertile group.The above differences were statistically significant (all P ＜0.05).Multivariate ordinal logistic regression analysis showed that the increased age (odds ratio[OR] 1.143,95％ confidence interval[CI] 1.104-1.185;P＜0.001),24 h SBP (OR 1.026,95％ CI 1.005-1.048;P =0.015),dSBP (OR 1.022,95％ CI 1.001-1.043;P =0.036),nSBP (OR 1.026,95％ CI 1.006-1.046;P=0.011),dSBPSD (OR 1.119,95％ CI 1.023-1.221;P=0.013),and nSBPSD (OR 1.107,95％ CI 1.022-1.200;P=0.013) were independently positively correlated with the overall WMH score.Multivariate linear regression showed that age (β=0.607,95％ CI 0.500-0.714;P＜0.001),24 h SBP (β=0.182,95％ CI 0.075-0.289;P=0.001),dSBP (β=0.156,95％ CI 0.049-0.264;P=0.004),and nSBP (β =0.200,95％ CI 0.092-0.307;P ＜0.001) were independently positively correlated with the PVWMH score;age (β =0.505,95％ CI 0.387-0.622;P ＜0.001),24 h SBP (β =0.132,95％ CI 0.015-0.248;P =0.027),dSBP (β =0.127,95％ CI0.011-0.243;P =0.032),nSBP (β =0.148,95％ CI 0.031-0.265;P =0.013),and nSBPSD (β =0.133,95％ CI 0.016-0.250;P=0.027) were independently positively correhted with the DWMH score.Conclusion The increased age,ambulatory systolic blood pressure level (24 h,daytime,nighttime) and systolic blood pressure variability level (dSBPSD and nSBPSD) were independently associated with the severity of WMHs.

Risk factors for white matter hyperintensities / 国际脑血管病杂志

White matter hyperintensities (WMHs) is a magnetic resonance imaging phenotype of cerebral small vessel disease,which is manifested as diffuse or confluent subcortical white matter.There is usually no clinical manifestation in the early stage of WMHs,and its pathophysiological mechanism has not been fully elucidated.Studies have shown that a variety of factors are associated with WMHs.The article reviews the risk factors for WMHs.

Influence of perivascular space enlargement on the prognosis of acute anterior circulation mild stroke / 医学研究生学报

Objective Few studies are reported on the influence of perivascular space enlargement (PVSE) on the prognosis of cerebral infarction. This study was to investigate the clinical correlation of EPVS in the basal ganglia and central semiovale with the prognosis of the first acute cerebral infarction (ACI) with anterior circulation mild small-artery occlusion (SAO).Methods We treated 137 cases of the first ACI with anterior circulation mild SAO in Tangshan Gongren Hospital from August 2015 to October 2016. According to the scores on PVSE in the basal ganglia and central semiovale, we divided the patients into a mild PVSE (score: 0-1) and a severe PVSE group (score: 2-4). Based on the National Institutes of Health Stroke Scale (NHISS) and the modified Rankin Scale (MRS) scores, we classified the outcome of neurological function recovery as good (MRS≥2) and poor (MRS<2) and analyzed the risk factors for the poor prognosis of ACI by logistic regression analysis.Results There were 60 cases of severe and 77 cases of mild PVSE in the in the basal ganglia as compared with 57 cases of severe and 80 cases of mild PVSE in the in the central semiovale. Good prognosis was achieved in 97 cases while poor prognosis observed in 40. Multivariate logistic regression analysis showed that the risk factors for the poor prognosis of ACI included NHISS at the onset (OR=5.393, 95% CI: 1.858-15.654), hypertension (OR=3.729, 95% CI: 1.310-10.610), and the severity of PVSE in the basal ganglia (OR=3.137, 95% CI: 1.343-7.325).Conclusion For the first acute cerebral infarction with anterior circulation mild small-artery occlusion, the severity of PVSE in the basal ganglia is an important factor affecting the recovery of neurological function.

Relationship between white matter lesion and cognitive impairment in the elderly according to their arterial spin labeling / 中华老年心脑血管病杂志

Objective To study the relationship between regional cerebral blood flow (rCBF) in matter lesion (WML) and cognitive impairment by arterial spin labeling (ASL).Methods Fourteen WML patients served as a WML group and 9 WML-free subjects served as a control group.Their neuropsychology was assessed and their rCBF was measured by ASL.Results The MoCA score,positive rate of symbol digit modalities test (SDMT),verbal fluency test (VFT) and digital span test forward and backward (DST F and B) were significantly lower while the trail making test-A (TMT-A) score and positive rate of Stroop B test and psychomotion speed test were significantly higher in WML group than in control group (P＜0.05,P＜0.01).The rCBF in regional WML was significantly slower in right and left semioval center,anterior and posterior horn of right and left lateral ventricle than that in normal white matter region (P＜0.01).The rCBF in WML was positively related with DST F and B (P＜0.05).The rCBF in NAWM was positively related with VFT (P＜0.01).Conclusion ASL can show the relationship between rCBF and cognitive impairment,especially executive function,attention and memory in elderly WML patients and decreased rCBF can thus increase their risk of cognitive impairment and dementia.

Effect of hypertension on motor function in Parkinson's disease patients with white matter lesion / 中华老年心脑血管病杂志

Objective To study the effect of hypertension on motor function in Parkinson's disease (PD) patients with white matter lesion (WML).Methods Two hundred and nineteen PD patients with WML were divided into hypokinesia group (n=137) and non hypokinesia group (n=82).The patients were followed up for 1 year.The relationship of vascular risk factors with hypertension and hypokinesia was analyzed.Results The age was older,the incidence of hypertension,DM and lipidemia was higher,the SBP and DBP were higher in hypokinesia group than in non hypokinesia group (P＜0.01,P＜0.05).Logistics regression analysis showed that age,hypertension and DM were the risk factors for hypokinesia in PD patients with WML (OR =1.78,95 ％CI:1.43-2.14,OR =1.97,95 ％0 CI:1.49-2.52,OR =1.63,95 ％ CI:1.31-1.94).Further analysis showed that grade 2 and 3 hypertension were closely related the risk of hypokinesia in PD patients with WML(OR=1.62,95％CI:1.29-1.95;OR=2.19,95％CI:1.49-2.91).Conclusion Hypertension,especially grade 2 and 3 hypertension,can aggravate hypokinesia in PD patients with WML.

Effect of telmisartan combined with rosuvastatin on white matter lesion in elderly hypertensive patients / 中华老年心脑血管病杂志

Objective To study the effect of telmisartan combined with rosuvastatin on white matter lesion (WML) in elderly hypertensive patients.Metheds Three hundred and twenty-nine elderly patients with mild-moderate essential hypertension (EH) were divided into control group (n=167) and combined treatment group (n=162).The patients in control group were treated with telmisartan (40 mg/d) and those in combined treatment group were treated with telmisartan plus rosuvastatin (10 mg/d).Their white matter hyperintensivity (WMH),periventricular white matter hyperintensity (PWMH),and deep white matter hyperintensity (DWMH) were measured by head MRI.Results The total WMH,PWMH and DWMH were significantly higher in two groups in the third and fifth years than at the baseline (P＜0.05).The growth rate of total WMH,PWMH and DWMH was significantly lower in combined treatment group than in control group in the third and fifth years (P＜0.05).Conclusion Telmisartan combined with rosuvastatin plays an important role in stablizing blood pressure,regulating blood lipids,and delaying WML.

Relationship of clinical and radiological characteristics with pathogenesis of acute small deep cerebellar infarction / 中华老年心脑血管病杂志

Objective To study the relationship of clinical and radiological characteristics with the pathogenesis of acute small deep cerebellar infarction (SDCI).Methods Ninety-five patients with acute small cerebellar infarction admitted to our hospital from April 2015 to April 2017 were divided into deep cerebellar infarction (DCI) group (n =20) and cortical infarction group (n =75).Their clinical and imaging characteristics were compared.Results The lacunar infarction score,leukoararaiosis score and microbleeds score were significantly higher [2 (1,2)score vs 1 (0,1) score,P=0.001;3(2,4)score vs 1(1,2)score,P=0.000;30.0％ vs 6.7％,P=0.041] while the incidence of AF and carotid or basilar artery atheromatous sclerosis was significantly lower (5.0％ vs 30.7 ％,P =0.040;15.0 ％ vs 40.0 ％,P =0.037;20.0 ％ vs 60.0 ％,P =0.001),the incidence of small artery lesions was significantly higher while that of atherosclerotic and cardiogenic throm bosis was significantly lower in DCI group than in cortical infarction group (P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that lacunar cerebellar infarction and cerebral microbleeds were the independent risk factors for DCI (OR=3.233,95％CI:1.538-6.795,P=0.002;OR=8.123,95％CI:2.182-5.301,P=0.009) and that DCI was positively related with small artery lesions (OR=5.481,95％CI:1.811-19.815,P=0.006).Conclusion SDCI is induced by small vessel lesions.

Etiology of single subcortical small infarction in middle cerebral artery / 中华老年心脑血管病杂志

Objective To study the relationship between single subcortical small infarction (SSSI) in middle cerebral artery (MCA) and large artery atheromatous sclerosis (LAAS).Methods One hundred and sixty patients with acute SSSI in MCA admitted to our hospital from January 2014 to December 2015 were divided into proximal infarction group (n=98) and distal infarction group (n=62).Their demographic,clinical,imaging data and National Institutes of Health Stroke Scale (NIHSS) score were recorded on admision.Results The incidence of coronary heart disease,NIHSS score,and contralateral intracranial artery stenosis were significantly higher while the incidence of proximal infarction,old lacunar infarction,and periventricular leukoaraiosis was significantly lower in proximal infarction group than in distal infarction group (21.4％ vs 3.2％,P=0.001;3 vs 2,P=0.030;19.4％ vs 1.6％,P=0.002;10.2％ vs 29.0％,P=0.002;16.3％ vs 33.9％,P=0.010).Logistic regression analysis showed that proximal infarction was independently related with old lacunar infarction,contralateral intracranial artery stenosis and periventricular leukoaraiosis (OR=0.270,95％CI:0.100-0.726,P=0.009;OR=4.500,95％CI:1.541-15.012,P=0.018;OR=0.325,95％CI:0.127-0.834,P=0.019).Conclusion Distal SSSI in MCA is related with small vessel disease while proximal SSSI in MCA is related with LAAS.

Multimode magnetic resonance imaging of leukoaraiosis / 国际脑血管病杂志

Leukoariaosis, or white matter lesions, are characterized by bilateral, mostly symmetrical hyperintensities on T 2-weighted imaging and fluid-attenuated inversion recovery MRI, and are associated with an increased risk of stroke, dementia, and cognitive decline. This article reiews multimode magnetic resonance imaging of leukoaraiosis, including structural and functional magnetic resonance imaging.

Correlation between white matter lesions and hematoma volume in patients with intracerebral hemorrhage / 国际脑血管病杂志

Objective To investigate the relationship between the severity of white matter lesions (WMLs) and the hematoma volume in patients with spontaneous intracerebral hemorrhage. Methods Patients with intracerebral hemorrhage (age ≥40 years) who were included in the Image Registration Center, Drum Tower Hospital, Nanjing University School of medicine from June 1, 2012 to May 31, 2017 were enrolled retrospectively. The head CT and baseline head MRI data were collected within 12 h after onset. The volume of hematoma on the baseline CT was calculated using ITK-SNAP software. The WMLs volume was semi-automatically segmented and calculated in the WMLs area by MRIcron software and ITK-SNAP software. According to the Fazekas score, the severity of WMLs was divided into mild ( 0-2), moderate (3-4) and severe (5-6). According to the median volume of hematoma, the patients were divided into smaller hematoma volume group and larger hematoma volume group. The baseline data in patients of both groups were compared. Multivariate logistic regression analysis was used to determine the independent related factors of hematoma volume. Results Age, National Institutes of Health Stroke Scale (NIHSS) score, and hematoma volume increased with the severity of WMLs, while the total cholesterol and low-density lipoprotein cholesterol levels decreased with the severity of WMLs. Hematoma volume was significantly associated with the NIHSS scores, apolipoprotein A1, D-dimer, WML volume, and intracerebral hemorrhage site. Multivariate logistic regression analysis showed that high WML score (odds ratio [OR] 1.001, 95% confidence interval [ CI] 1.002-1.008; P=0.049), intracerebral hemorrhage site ( OR 1.441, 95% CI 1.090-1.911; P=0.010), and NIHSS score (OR 1.081, 95% CI 1.011-1.152; P=0.031) were the independent risk factors for larger hematoma volume. Conclusion The severity of WMLs was significantly positively correlated with the baseline hematoma volume in patients with spontaneous intracerebral hemorrhage.

The Effect of Leukoaraiosis on the Severity and Course of Delirium / 정신신체의학

OBJECTIVES: The significance of leukoaraiosis on brain magnetic resonance imaging (MRI) is uncertain, but it is often seen with vascular risk factors or in the context of cognitive impairment. We aimed to investigate the effect of leukoaraiosis on the severity and course of delirium. METHODS: Periventricular hyperintensity and deep white matter hyperintensity on brain MRI were rated in 42 patients with delirium by semiquantative visual rating scale. Correlations between their grades and the scores of Korean version of Delirium Rating Scale-Revised-98 (K-DRS-R-98) were analyzed, and the interaction effects between the groups according to the levels of leukoaraiosis and two evaluation points were also analyzed. RESULTS: The grade of deep white matter hyperintensity in the occipital lobe was positively correlated with the scores on the total, severity items, cognitive items, and non-cognitive items of K-DRS-R-98. The cognitive items scores of K-DRS-R-98 in the low grade group of periventricular hyperintensity showed significantly steeper decrease than the high grade group. CONCLUSIONS: A difference in severity or recovery speed of delirium according to the level of leukoaraiosis may result from disruption in brain functional connectivity. Our results have a clinical implication in that the severity and course of delirium can be possibly predicted using the level of leukoaraiosis.

Correlation between white matter lesion score and volume and cerebral microbleeds in patients with cerebral small vessel disease / 国际脑血管病杂志

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.

Pathophysiological mechanism of white matter hyperintensities in patients with hypertension / 国际脑血管病杂志

As one of the imaging manifestations of cerebral small vessel disease,white matter hyperintensities (WMHs) are very common in the elderly,and are closely related to motor dysfunction and cognitive impairment in the elderly.Due to the large pathological heterogeneity of WMHs,the current understanding and research on its occurrence and development mechanism is limited,so its prevention and treatment is still a difficult problem.Studies have shown that age and hypertension are the major risk factors for WMHs.This article reviews the effects of hypertension on WMHs and their progression and pathophysiological mechanisms,with a view to finding new strategies for the prevention,diagnosis and treatment of WMHs.