Characteristics of cognitive and neuropsychiatric behavioral features of Alzheimer's disease with white matter lesion

Abstract

Objective To study the characteristics of cognitive and neuropsychiatric behavioral features of Alzheimer's disease (AD) with white matter lesion (WML). Methods A total of 58 cases of AD patients were reruited from January 2010 to December 2020. The Mini⁃Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate the degree of cognitive impairments. Activities of Daily Living Scale (ADL) was used to evaluate the abilities of daily living. Neuropsychiatric Inventory (NPI) was used to evaluate behavioral and psychological symptoms. The Hamilton Depression Rating Scale 21⁃Items (HAMD⁃21) was used to evaluate the mental or emotional state. Clinical Dementia Rating Scale (CDR) was used to evaluate the dementia severity. The Fazekas scale was utilized to assess the severity of periventricular white matter hyperintensities (PWMH) and deep white matter hyperintensities (DWMH). Results 1) The distribution frequency of hypertension (χ²=4.665, P=0.031), NPI score (Z=1.987, P=0.047), CDR score (Z=2.069, P=0.039), MMSE score (t=2.927, P=0.005) and MoCA score (t=3.394, P=0.001) in WML group were significantly different than those in non⁃WML group. Among which, attention and calculation ability (Z=2.234, P=0.025), recall ability (Z=2.792, P=0.005), naming ability (Z=2.382, P=0.017), retelling ability (Z=2.685, P=0.007) were lower than those in non⁃WML group. The incidence of delusion (Fisher's exact probability: P=0.046), depression/dysthymia (χ²=4.376, P=0.036), apathy/indifference (χ²=4.063, P=0.044) in WML group were significantly higher than those in non⁃WML group. 2) The distribution frequency of hypertension (χ²=11.195, P=0.001), low⁃density lipoprotein cholesterol (LDL⁃C; t=2.573, P=0.013), ADL score (Z=3.269, P=0.001), NPI score (Z=3.439, P=0.001) and CDR score (t=2.740, P=0.006) in moderate to severe WML group were higher than those in mild WML group. MMSE score (t=3.686, P=0.001) and MoCA score (t=5.225, P=0.000) were lower than those in without or mild WML group. 3) Homocysteine (Hcy; F=6.291, P=0.003), distribution frequency of hypertension (χ²=10.716, P=0.005), distribution frequency of WML (χ²=8.100, P=0.017), total Fazekas scores (H=13.658, P=0.001), Fazekas score of PWMH (H=6.540, P=0.038) and Fazekas score of DWMH (H=21.550, P=0.000) were statistically significant. While distribution frequency of hypertension(χ²=6.702, P=0.010; Fisher's exact probability: P=0.006), Hcy (P=0.039, 0.001), Fazekas total scores (Z=2.898, P=0.004; Z=3.223, P=0.001) and Fazekas score of DWMH (Z=2.807, P=0.005; Z=4.144, P=0.000) in severe dementia group were higher than those in moderate and mild dementia group, and only the distribution frequency of WML was higher than that in mild dementia group (Fisher's exact probability: P=0.008), Fazekas score of PWMH was higher than that in moderate dementia group (Z=2.567, P=0.010), and Fazekas score of DWMH in moderate dementia group was higher than that in mild dementia group (Z=2.950, P=0.003). 4) The total Fazekas scores (Z=3.284, P=0.001) and DWMH scores (Z=4.083, P=0.000) in AD patients with hypertension were significantly higher than those in AD patients without hypertension. Conclusions The degree of WML was closely related to cognitive function and neuropsychiatric behavioral symptoms of AD patients, which can be used as an observation index for the development of AD. Therefore, we should pay attention to early screening and prevention of WML related risk factors.

doi：10.3969/j.issn.1672⁃6731.2021.11.006