Correlation analysis of the risk factors for subcortical vascular cognitive impairment

Abstract

Objective Subcortical ischemic vascular disease (SIVD), characterised by multiple lacunar infarcts and white matter lesion (WML), has been considered as a major cause of subcortical vascular cognitive impairment (SVCI). The objective of the study is to identify the risk factors for SVCI in a group of SIVD patients who were registered in a stroke secondary prevention clinic. Methods Based on the detailed neuropsychological investigation and clinical interview, 61 cases that met the criteria of SIVD were recruited and classified as 3 groups of different cognitive state: no cognitive impairment (NCI), vascular cognitive impairment no dementia (VCI⁃ND) and vascular dementia (VaD). The latter two were further grouped as vascular cognitive impairment (VCI). Their demographic data, vascular risk factors and neuroimaging information were documented. Results 1) The total prevalence of VCI (VCI⁃ND and VaD) was 63.93% (39/61). The prevalence of VCI ⁃ ND and VaD were 36.07% (22/61) and 27.87% (17/61), respectively. 2) There were significant differences of age and educational years among NCI, VCI⁃ND and VaD groups (P = 0.032, 0.019). Paired comparison showed that VaD patients were older and less educated than NCI patients (P = 0.029, 0.022). The age difference between NCI and VCI groups nearly approached statistical significance (t = 3.740, P = 0.058), while the year of education of VCI was significantly lower than that of NCI (t = 7.888, P = 0.007). 3) There were significant differences of diabetes mellitus (DM) cases among NCI, VCI ⁃ ND and VaD groups (P = 0.037). There were more DM cases in VCI group than those in NCI group (P = 0.012), but no significant statistical difference was found among other vascular risk factors. 4) There was no difference of lacunar infarcts in different site of subcortical grey matter among these groups, respectively (P > 0.05, for all). Significant differences of subcortical white matter infarcts, WML scores and medial temporal atrophy (MTA) scores were found in patients in NCI, VCI⁃ND and VaD group (P = 0.020, 0.001, 0.000). The number of lacunar infarcts within white matter in VaD group was higher than that in NCI group (P = 0.027). The WML scores of VaD was much higher than that of VCI⁃ND and NCI (P = 0.001, 0.017). The MTA scores of VaD patients was much higher than that of VCI⁃ND and NCI patients (P = 0.001, 0.000). The number of white matter lacunar infarcts, the WML scores and the MTA scores of VCI was much higher than that of NCI (t = ⁃ 2.661, P = 0.003; t = ⁃ 2.953, P = 0.005; t = ⁃ 4.712, P = 0.000). 5) Logistic regression showed that DM, the number of white matter infarcts and MTA scores were independent risk factors for SVCI. Conclusion SVCI is common in SIVD patients and related to DM, ischemic and degenerative injuries of the brain.

DOI：10.3969/j.issn.1672-6731.2010.03.012