Analysis the relationship of cholinergic pathway damage and cerebral cortex structure change in patients with cognitive impairment accompanied by white matter hypertensity

Abstract

Objective To investigate the relationship of cholinergic pathway (CP) damage and cerebral cortex structure change in patients with different degree of cognitive impairment accompanied by white matter hyperintensity (WMH). Methods From March 2016 to December 2018, a total of 80 patients with WMH were rolled into WMH with no cognitive impairment group (WMH⁃CN group, n = 43), WMH with vascular cognitive impairment⁃no dementia group (WMH⁃VCIND group, n = 21) and WMH with vascular dementia group (WMH ⁃ VaD group, n = 16), according to Montreal Cognitive Assessment (MoCA) and Clinical Dementia Rating Scale (CDR). White matter damage in CP were evaluated by Cholinergic Pathways Hyperintensities Scale (CHIPS). MRI was performed on all patients, 34 regions of interest (ROIs) in cerebral cortex CP were marked, and layer thickness and volume were measured. Spearman rank correlation analysis and partial correlation analysis were performed to explore the correlation between the total CHIPS score of left and right hemispheres and ipsilateral cortical ROIs thickness and volume. Results 1) The CHIPS scores of WMH ⁃ CN group, WMH ⁃ VCIND group and WMH ⁃ VaD group had statistically significant differences in the whole brain (P = 0.023), the left hemisphere (P = 0.039) and the right hemisphere (P = 0.004), respectively. Among them, the CHIPS scores of WMH⁃VCIND group (P = 0.002, 0.000, 0.001) and WMH⁃VaD group (P = 0.000, 0.003, 0.000) were all higher than those of WMH⁃CN group. The CHIPS scores of three regions in WMH⁃VaD group were also higher than those in WMH⁃VCIND group (P = 0.008, 0.013, 0.020). 2) The differences of the left hemisphere ROIs layer thickness (P =0.000) and volume (P = 0.000), and the right hemisphere ROIs layer thickness (P = 0.000) were statistically significant between WMH patients and normal controls. The left hemisphere ROIs layer thickness (P =0.000, for all) and volume (P = 0.000, for all), and the right hemisphere ROIs layer thickness (P = 0.000, for all) in WMH⁃CN group, WMH⁃VCIND group and WMH⁃VaD group were all lower than those in control group. In WMH⁃VaD group, the thickness of left ROIs was higher than that of WMH⁃CN group (P = 0.000) and WMH⁃VCIND group (P = 0.036). In WMH⁃CN group, the volume of left ROIs was higher than that in WMH⁃VCIND group (P = 0.033) and lower than that in WMH⁃VaD group (P = 0.025), and the thickness of right ROIs in WMH⁃VCIND group (P = 0.001) and WMH⁃VaD group (P = 0.000) were both higher than that in WMH ⁃ CN group. 3) Correlation analysis showed that only the WMH ⁃ VCIND group had a positive correlation between left hemispheric CHIPS score and ipsilateral cortical ROIs (r = 0.439, P = 0.047). Conclusions When WMH patients with cognitive impairment, as the degree is aggravating, the thickness and volume of 34 ROIs on left hemisphere CP have a certain degree of decline. The cerebral cortex structure change was positively associated with the degree of left hemisphere CP damage, but the structural change is not obvious in right hemisphere.

DOI:10.3969/j.issn.1672⁃6731.2020.10.009