Cognitive function and cerebral ndcrobleeds in patients with ischendc stroke： a retrospective case series study

Objective To investigate the risk factors for vascular cognitive irnpairment and the effet of cerebral microbleeds （CMBs） on cognitive function in patients with ischemic stroke. Methods The data of patients with ischemic stroke over the age of 50 were collected. The Montreal cognitive assessment （MoCA） scale and Alzheimer＇s disease assessment scale-cognitive subscale were used to evaluate cognitive function. Hamilton depression scale （HAMD） was used to evaluate the depression status in order to exclude the patients with depression. The patients with ischemic stroke were divided into either a cognitive impairment group or a non-cognitive impairment group according to the scale evaluation results. The demographic and clinical characteristics in both groups were compared, and the multivariate logistic regression analysis was used to look for the independent risk factors for cognitive impairment in patients with ischemic stroke. The Spearman rank correlation method was used to analyze the degree of CBMs, total score of MoCA, and the correlations of all cognitive domains scores. Results A total of 169 patients with ischemic stroke were enrolled in the study. There were 80 patients in the cognitive impairment group and 89 in the non-cognitive impairment group; 34 patients had CMBs and 135 had no CMBs. The age was older （71.99 ±6. 01 years vs. 64. 47 ±6. 15 years; t =8. 014, P =0. 000）, years of education were fewer （4. 51 ± 1. 534 years vs. 6. 94 ±2. 357 years; t =8. 023, P =0. 000）, systolic blood pressure was higher （156.19±17.53 mmHgvs. 142.04± 16.03 n maHg 1 mmHg= 0. 133 kPa; t = 5.479, P = 0. 000）, scale of white matter lesion was higher （7. 33 ±2. 04 vs. 4. 39 ±2. 17; t = 8. 951, P =0. 000）, cerebral infarction volume was larr （7 123.8 ±1 587. 1 mrrs. 5 628.4 -1 017. 8 mm3; t = 7. 201; P = 0. 000）, proportion of the patients with history of previous stroke or transient ischemic attack in the coaitive impairment group. Multivariate logistic regression analysis showed that the age （odds ratio [OR] 1. 115, 95% confidence interval [CII 1. 013 - 1. 227; P =0. 026）, years of education （OR O. 490, 95% CIO. 325 -0. 793; P=0. 001）, systolic blood pressure （OR 1. 048, 95% CI 1. 014 - 1. 083; P=0. 005）, scale of white matter lesion （OR 2. 044, 95% CI 1. 466 - 2. 851; P = 0. 000）, and cerebral infarction volume （OR 2. 204, 95% CI 1. 386 -3. 503; P =0. 001） were all the independent risk factors for cognitive impairment in patients with ischemic stroke. Compared to the non-CBM group, the age was older （72. 06 ±5.59 years vs. 67. 01 ±7. 15 years; t =4. 427; P=0. 000）, years of education were fewer （3.97 ± 1. 381 years vs. 6. 25 ±2. 317 years; t =7. 367, P =0. 000）, systolic blood pressure was higher （155.03 ±0. 16 mm Hg vs. 147. 16 ± 17. 32 rnm Hg; t =2. 290, P =0. 023）, scale of white matter lesion was more higher （7. 03 ±. 139 vs. 5.47 ±2. 591; t = 3. 247, P = 0. 001）, cerebral infarction volume was larger （6 968. 5 ±1 507.4 mm3 vs. 6 177. 0 ± 477. 1 mrnS; t = 2. 735, P = 0. 007）, and proportions of hypertension （82. 4% vs. 41.5% ;X2 = 18. 149, P = 0. 000）, hyperlipidemia （88.2% vs. 39. 3% ;X2 =26. 067, P =0. 000）, history of previous stroke or transient ischemic attack （70. 6% vs. 28. 1% ;X2 =21. 061, P =0. 000） and coronary heart disease （94. 1% vs. 45.2% ; X2 =26. 278, P =0. 000） were higher in the CBM group. The MoCA total score （M[Q1 - Q3] ; 24 [24 -25] vs. 28[27 -28];Z= -7.092,P〈0.000） as well as the scores of attention （6[5 -6] vs. 616-6];Z= - 2. 502, P = 0. 012）, abstraction （2 [1 - 2] vs. 2 [2 - 2] ; Z = - 2. 382, P = 0. 017） and visuoexJecutive （2 [1 - 2] vs. 4[4 -53; Z = -7. 321, P=0. 000） in the CMB group were significantly lower than those in the nonCBM group. The Spearnaan rank correlation analysis showed that the CMB grade was negatively associated with the MoCA total score （r, = - 0. 879, P = 0. 000） as well as the scores of visuoexecutive （r, = - 0. 895, P =0. 000）, attention （rs = -0. 337, P =0. 005）, and abstraction （r, = -0. 333, P=0. 006）. Conclusions The age, years of education, systolic blood pressure, degree of white matter damage, and cerebral infarction volume are the risk factors for vascular coaitive impairment. The visuospatial executive dysfunction, attention and abstract thinking decline sigrfificantly in ischemic stroke patients with CBMs. CMBs and their numbers are closely associated with cognitive impairment. The more the CMB numbers are, the more obvious the cognitive impairment will be. Key words: Cerebral Hemorrhage;  Brain lscherma;  Stroke;  Cogutxon Disorders;  M agaetlc ResonanceImaging;  Neuropsychological Tests;  Risk Factors

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