Cognitive impairment in cerebral small vessel disease induced by hypertension

Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease,the most common cerebrovascular disease.Howeve r,the causal relationship between hypertension and cerebral small vessel disease remains unclear.Hypertension has substantial negative impacts on brain health and is recognized as a risk factor for cerebrovascular disease.Chronic hypertension and lifestyle factors are associated with risks for stro ke and dementia,and cerebral small vessel disease can cause dementia and stroke.Hypertension is the main driver of cerebral small vessel disease,which changes the structure and function of cerebral vessels via various mechanisms and leads to lacunar infarction,leukoaraiosis,white matter lesions,and intracerebral hemorrhage,ultimately res ulting in cognitive decline and demonstrating that the brain is the to rget organ of hypertension.This review updates our understanding of the pathogenesis of hypertensioninduced cerebral small vessel disease and the res ulting changes in brain structure and function and declines in cognitive ability.We also discuss drugs to treat cerebral small vessel disease and cognitive impairment.

Correlating cognitive impairment with carotid atherosclerosis and carotid artery stenosis in patients with acute cerebral infarction

BACKGROUND：Studies have demonstrated that carotid atherosclerosis and carotid artery stenosis are closely associated with cognitive impairment in patients with and without clinically evident cerebrovascular disease. OBJECTIVE： To investigate the correlation between the degree of pathological changes in carotid atherosclerosis, carotid artery stenosis, and cognitive impairment in patients with acute cerebral infarction through the use of color Doppler imaging. DESIGN, TIME AND SETTING： The present concurrent, non-randomized, controlled experiment was performed at the Departments of Neurology and Ultrasound, Affiliated Hospital of North Sichuan Medical College between November 2006 and August 2007. PARTICIPANTS： Fifty-five patients with cerebral infarction, consisting of 35 males and 20 females, aged 50–82 years, were admitted to the hospital between November 2006 and August 2007 and recruited for this study. An additional 30 subjects consisting of 18 males and 12 females, aged 47–78 years, that concurrently received a health examination at the same hospital, were also included as normal controls. METHODS： Intima-media thickness （IMT）, plaque shape, size, and echo intensity of all subjects were detected by color Doppler flow imaging. Assessment criteria： IMT 〉 1.0 mm was considered to be intimal thickening, and IMT 〉 1.2 mm was determined to be formed atherosclerotic plaques. In the position of the largest plaque, the degree of carotid artery stenosis was determined by the following formula： （1-cross-sectional area of residual vascular luminal area/vascular cross-sectional area） × 100%. Less than 30% exhibited mild stenosis, 30%-40% moderate stenosis, and 〉 50% severe stenosis. MAIN OUTCOME MEASURES： IMT and the degree of carotid artery stenosis were evaluated by color Doppler flow imaging. The Mini-Mental State Examination （MMSE）, as well as the clinical memory scale, was compared between patients with cerebral infarction and normal controls. RESULTS： In the cerebral infarction group, IMT was increased, the degree of carotid artery stenosis was aggravated, and the MMSE and MQ scores of clinical memory scale were decreased. In particular, orientation of time and place, attention, calculation, and short-time memory were decreased. There were statistically significant differences in MMSE and MQ of clinical memory scale between patients with cerebral infarction and normal controls （P 〈 0.01）. The scores from the two scales were significantly lower in patients with cerebral infarction with carotid plaque subgroup compared to the cerebral infarction with no carotid plaque subgroup （P 〈 0.01）. The scores from the two scales were also significantly lower in patients with IMT 〉 1.0 mm, as well as moderate and severe carotid artery stenosis, compared to patients with IMT ≤ 1.0 mm, and normal and mild stenosis group （P 〈 0.05）. CONCLUSION： More severe atherosclerotic and carotid artery stenosis leads to more obvious cognitive impairment.

Effects of Yinxingdamo Injection Combined with Oxiracetam Capsule on Cognitive Function and Neurological Deficit in Patients with Acute Cerebral Infarction

OBJETTIVE: To observe the effects of Yinxingdamo Injection combined with oxiracetam capsule on cognitive function and neurological deficit in patients with acute cerebral infarction. METHODS: A total of 76 patients with acute cerebral infarction were randomly divided into observation group and control group, with 38 patients in each group. Patients in the control group were treated with conventional western medicine and oxiracetam capsules while patients in the observation group were given Yinxingdamo injection intravenous drip treatment on the basis of the same treatment. After 4 weeks of treatment, the cognitive function of the two groups before and after treatment was observed [Simple Intelligence Scale(MMSE Score), Montreal Cognitive Assessment Scale(MoCA Score)], Neurological Deficit [Chinese Stroke Scale(CSS Score), Daily Life Activity ability(ADL score)], free radical biochemical indicators [malondialdehyde(MDA), oxide dismutase(SOD)] changes, and statistical effects of two groups. RESULTS: After treatment, the total effective rate of the observation group was 92.1%, which was significantly higher than 73.7% of the control group(P < 0.05). The MMSE score and MoCA score of the two groups were significantly increased after treatment(P < 0.05), and the MMSE score and MoCA score inobservation group were significantly increased after treatment than the control group(P < 0.05). The CSS scores of the two groups were significantly decreased after treatment(P < 0.05), and the ADL scores were significantly increased(P < 0.05). The improvement of CSS score and ADL score in the observation group were significantly better than those in the control group(P < 0.05), and serum MDA levels were significantly decreased in both groups after treatment(P < 0.05), and SOD levels were significantly increased(P < 0.05), and the improvement of MDA and SOD levels in the observation group was significantly better than that in the control group group(P < 0.05). CONCLUSION: Yinxingdamo injection combined with oxiracetam capsule can effectively inhibit the oxygen free radical reaction injury in patients with acute cerebral infarction, and significantly improve the symptoms of cognitive dysfunction and neurological deficit in patients. Its curative effect is exact and worthy of clinical application.

The clinical and experimental study of the efficacy of nimodiping in cognitive rehabilitation of cerebral infarction

Objective To study the efficacy of nimodipine in cognitive rehabilitation of the cerebral infarction.Method (1)Experimental animal models were created in 24 month old Wistar rats,which were treated with nimodipine.Results were compared among the drug treated group,non treated of the same age mice group and 8 month old mice group.(2)Clinical research of nimodipine was conducted in 67 cerebral infarction patients with cognitive impairments.HDS was used as measuring tool.(3)To analyze the related factors such as age,Barthel index and FAQ.Result After 1 month treatment of nimodipine,significant differences between drug dealing and non drug dealing groups were showed in the Y maze discrimination learning experiment(P< 0.05),the duration and errors were improved in drug treated group compared with control group.No significant different result was found in one trial passive avoidance response experiment(P >0.05);single factor analysis(including Barthel index,FAQ and age) did not show significance(P >0.05);there is no statistical differences between nimodipine treated patients and non drug treatment patients(P >0.05).Conclusion Nimodipine showed no efficacy to cognitive rehabilitation in cerebral infarctions.

Effects of angiotensin converting enzyme inhibitors on cognitive function, apoptosis and oxidative stress in brain tissue of rats with cerebral infarction

Objective:To study the effects of angiotensin converting enzyme inhibitor(ACEI)on cognitive function,apoptosis and oxidative stress in brain tissue of rats with cerebral infarction.Methods:Adult male SD rats were randomly divided into control group,cerebral infarction group and ACEI group.The latter two groups were used to establish cerebral infarction model by thread embolism.The ACEI group was given oral administration of fosinopril 10mg/kg,and the other two groups were given oral administration of saline.The differences of Morris water maze cognitive function,apoptotic genes and oxidative stress indexes were compared among the three groups.Results:The escape latency of rats in cerebral infarction group was significantly longer than that in control group,the number of times of platform crossing was significantly less than that in control group,the duration of platform stay was significantly shorter than that in control group,the mRNA expression levels of Bcl-2 associated X protein(Bax),factor associated suicide(Fas),Fas ligand(FasL)and Caspase-3,the protein expression levels of phosphorylated Janus kinase(p-JAK2)and phosphorylated signal transducer and activator of transcription(p-STAT3)as well as the contents of reactive oxygen species(ROS)and malonaldehyde(MDA)in brain tissue were significantly higher than those in control group,and the mRNA expression level of B-cell lymphoma-2(Bcl-2)as well as the contents of catalase(CAT)and superoxide dismutase(SOD)in brain tissue was significantly lower than those in control group.The escape latency of rats in ACEI group was significantly shorter than that in cerebral infarction group,the number of times of platform crossing was significantly more than that in cerebral infarction group,the duration of platform stay was significantly longer than that in cerebral infarction group,the mRNA expression levels of Bax,Fas,FasL and Caspase-3,the protein expression levels of p-JAK2 and p-STAT3 as well as the contents of ROS and MDA in brain tissue were significantly lower than those in cerebral infarction group,and the mRNA expression level of Bcl-2 as well as the contents of CAT and SOD in brain tissue was significantly higher than those in cerebral infarction group.Conclusions:ACEI can improve the cognitive function of rats with cerebral infarction and inhibit the apoptosis and oxidative stress in ischemic brain tissue.

Changes of auditory evoked magnetic fields in patients after acute cerebral infarction using magnetoencephalography

Auditory evoked magnetic fields were recorded from 15 patients with acute cerebral infarction and 11 healthy volunteers using magnetoencephalography.The auditory stimuli of 2 kHz pure tone were binaurally presented with an interstimulus interval of 1 second.The intensity of stimuli was 90 dB and the stimulus duration was 8 ms.The results showed that the M100 was the prominent response, peaking approximately 100 ms after stimulus onset in all subjects.It originated from the area close to Heschl’s gyrus.In the patient group,the peak latency of M100 responses was significantly prolonged,and the mean strength of equivalent current dipole was significantly smaller in the affected hemisphere.The three-dimensional inter-hemispheric difference of the M100 positions was increased in the patient group.Our experimental findings suggested that impairment of cerebral function in patients with acute ischemic stroke can be detected using magnetoencephalography with the higher spatial resolution and temporal resolution.Magnetoencephalography could provide objective and sensitive indices to estimate auditory cortex function in patients with acute cerebral infarction.

Significance of neuroglobin in serum of acute atherosclerotic cerebral infarction patients

This study sought to examine neuroglobin （NGB） in the serum of acute cerebral infarction patients with double-antibody sandwich enzyme-linked immunosorbent assay to identify all risk factors, calculate infarct size, assess neurological impairment, and analyze the relation between NGB and each of these factors. The double-antibody sandwich assay indicated that levels of NGB in serum were unaltered within 6 hours following acute cerebral infarction compared with normal levels. NGB levels then underwent a distinct change, peaking at 24 hours then returning to normal levels in 72 hours. The results suggest that the level of NGB might be related to infarct size and low-density lipoprotein at 24 hours after acute cerebral infarction. There were no significant differences in neurological impairment scores and infarct size at different periods following infarction. The findings indicated that the level of NGB in serum of acute cerebral infarction patients was correlated with infarct time.

Offspring of rats with cerebral hypoxia-ischemia manifest cognitive dysfunction in learning and memory abilities

Neonatal hypoxic-ischemic encephalopathy is a serious neurological disease,often resulting in long-term neurodevelopmental disorders among surviving children.However,whether these neurodevelopmental issues can be passed to offspring remains unclear.The right common carotid artery of 7-day-old parental-generation rats was subjected to permanent ligation using a vessel electrocoagulator.Neonatal hypoxic-ischemic rat models were established by subjecting the rats to 8%O2–92%N2 for 2 hours.The results showed that 24 hours after hypoxia and ischemia,pathological damage,cerebral atrophy,liquefaction,and impairment were found,and Zea-Longa scores were significantly increased.The parental-generation rats were propagated at 3 months old,and offspring were obtained.No changes in the overall brain structures of these offspring rats were identified by magnetic resonance imaging.However,the escape latency was longer and the number of platform crossings was reduced among these offspring compared with normal rats.These results indicated that the offspring of hypoxic-ischemic encephalopathy model rats displayed cognitive impairments in learning and memory.This study was approved by the Animal Care&Welfare Committee of Kunming Medical University,China in 2018(approval No.kmmu2019072).

Efficacy of acupuncture in combination with medicine for mild cognitive impairment after cerebral infarction:a randomized controlled trial

Objective To observe the clinical effect of acupuncture in combination with medicine in the treatment of mild cognitive impairment after cerebral infarction as well as the impact on patients＇ daily living ability. Methods Seventy-two patients, in accordance with random number table, were divided into two groups, acupuncture combined with western medicine group （group A） and western medicine group （group B）, each group with 36 patients. In combination with nimodipine tablets, acupuncture which can regulate the mind and reinforce the intelligence [making Baihui （百会 GV 20）, Sishencong （四神聪EX-HN 1）, Sibai （四白 ST 2）, Fengchi （风池 GB 20）, Wanggu （完骨 GB 12）, Tianzhu （天柱 BL 10）, Shenmen （神门 HT 7）, Neiguan （内关 PC 6）, Shuigou （水沟 GV 26）, Sanyinjiao （三阴交 SP 6）, Taichong （太冲 LR 3）, Fenglong （丰隆 ST 40） as the main acupoints] was given in the treatment group （group A） while only nimodipine tablets were given in the control group （group B）. The efficacy of these two groups was evaluated by Montreal Cognitive Assessment （MoCA） Scale after the continuous treatment for three months. Results The remarkably effective rate was 69.4%.and the total effective rate was 91.7% in the treatment group, while the remarkably effective rate was 55.6% and the total effective rate was 80.6% in the control group; the differences between the two groups were statistically significant （P〈0.05）. When comparing the MoCA score before and after treatment, which was 20.23±4.67 before treatment and 26.84±3.87 after treatment in group A; 19.82±3.56 before treatment and 23.33±2.78 after treatment in group B, it was found that the score for both groups became higher after treatment than that before treatment. Furthermore, the increase of the score was higher in the treatment group （6.61±0.80） than that in the control group （3.51±0.78） and the differences were statistically significant （P〈0.05）. Conclusion Acupuncture, which can regulate the mind and reinforce the intelligence, combined with nimodipine tablets is an effective therapy for the treatment of mild cognitive impairment after cerebral infarction, which is superior to single treatment with nimodipine tablets.

Microbleeds in fronto-subcortical circuits are predictive of dementia conversion in patients with vascular cognitive impairment but no dementia

Cerebral small vessel disease（CSVD） is a common etiology of vascular cognitive impairment with no dementia（V-CIND）. Studies have revealed that cerebral microbleeds（CMBs）, a feature of CSVD, contribute to cognitive impairment. However, the association between CMBs and dementia conversion in individuals with V-CIND is still unclear. Here, we analyzed the predictive role of CMBs in the conversion from V-CIND to dementia in CSVD patients. We recruited and prospectively assessed 85 patients with CSVD and V-CIND. V-CIND was evaluated using a series of comprehensive neuropsychological scales, including the Chinese version of the Montreal Cognitive Assessment and the Clinical Dementia Rating. MRI assessments were used to quantify lacunar infarcts, white matter hyperintensities, CMBs, and medial temporal lobe atrophy. Eighty-two of the 85 patients completed the assessment for dementia conversion at a 1-year follow-up assessment. Multivariate logistic regression analyses were conducted to examine independent clinical and MRI variables associated with dementia conversion. Twenty-four patients（29.3%） had converted to dementia at the 1-year follow-up, and these individuals had significantly more CMBs in the fronto-subcortical circuits. Multivariate logistic regression analyses revealed that the patients with CMBs in the fronto-subcortical circuits（odds ratio = 4.4; 95% confidence interval： 1.602-12.081, P = 0.004） and 5 or more CMBs overall（odds ratio = 17.6, 95% confidence interval： 3.23-95.84, P = 0.001） had a significantly increased risk of dementia at the 1-year follow-up. These findings indicate that CMBs in the fronto-subcortical circuits may be predictive of dementia conversion in CSVD patients with V-CIND, and thus extend the clinical significance of CMBs.

β2-Microglobulin exacerbates neuroinflammation,brain damage,and cognitive impairment after stroke in rats

β2-Microglobulin(β2M),a component of the major histocompatibility complex class I molecule,is associated with aging-related cognitive impairment and Alzheimer’s disease.Although upregulation ofβ2M is considered to be highly related to ischemic stroke,the specific role and underlying mechanistic action ofβ2M are poorly understood.In this study,we established a rat model of focal cerebral ischemia by occlusion of the middle cerebral artery.We found thatβ2M levels in the cerebral spinal fluid,serum,and brain tissue were significantly increased in the acute period but gradually decreased during the recovery period.RNA interference was used to inhibitβ2M expression in the acute period of cerebral stroke.Tissue staining with 2,3,5-triphenyltetrazolium chloride and evaluation of cognitive function using the Morris water maze test demonstrated that decreasedβ2M expression in the ischemic penumbra reduced infarct volume and alleviated cognitive deficits,respectively.Notably,glial cell,caspase-1(p20),and Nod-like receptor pyrin domain containing 3(NLRP3)inflammasome activation as well as production of the inflammatory cytokines interleukin-1β,interleukin-6,and tumor necrosis factor-αwere also effectively inhibited byβ2M silencing.These findings suggest thatβ2M participates in brain injury and cognitive impairment in a rat model of ischemic stroke through activation of neuroinflammation associated with the NLRP3 inflammasome.

Cerebrovascular hemodynamics in patients with cerebral arteriosclerosis

The present study observed hemodynamic changes in 26 patients with cerebral arteriosclerosis using a cerebral circulation dynamics detector and transcranial Doppler. In patients with cerebral arteriosclerosis the blood supply and flow rate in the bilateral carotid arteries and the blood flow rate in the anterior cerebral and middle cerebral arteries were similar to normal controls, but the cerebral vascular resistance, critical pressure and pulsatility index were increased, and cerebral arterial elasticity and cerebral blood flow autoregulation were decreased. Compared with the lesioned hemisphere of patients with cerebral infarction, the total blood supply and blood flow rate of patients with cerebral arteriosclerosis were higher. Compared with normal subjects, patients with cerebral arteriosclerosis exhibited cognitive disturbances, mainly in short-term memory, attention, abstract capability, and spatial and executive dysfunction. Results showed that cerebral arteriosclerosis does not directly affect the blood supply of a cerebral hemisphere, but affects cognitive function. The increased cerebral vascular resistance and reduced autoregulation of cerebral blood vessels may be important hemodynamic mechanisms of arteriosclerosis-induced cerebral infarction.

Therapeutic Efficacy Observation on Acupuncture Treatment for Vascular Cognitive Disorder Following a Cerebral Infarction

Objective：To observe the event related potential 300 （P300） after scalp acupuncture treatment in patients with cognitive disorder due to cerebral infarction,and evaluate its therapeutic effect.Methods：Sixty-six patients aged below 70 years old with cognitive disorder after initial onset of cerebral infarction were randomized into a treatment group and a control group.Conventional neurological drugs and physical trainings were prescribed to both groups.In addition,the treatment group received scalp acupuncture.The two groups were compared by evaluating the latency and amplitude of P300 before and after the 3-month treatment.Results：After treatment,the latency of P300 was shortened by 39.1 ms in the treatment group,versus 16.7 ms in the control group,and the difference was statistically significant （P0.05）.Conclusion：P300 can objectively evaluate the therapeutic effect of scalp acupuncture in treating the patients with cognitive disorder due to cerebral infarction.Scalp acupuncture has positive effect in treating this group of patients.

Cognitive impairment in two subtypes of a single subcortical infarction

Background:Single subcortical infarction(SSI)is caused by two main etiological subtypes,which are branch atheromatous disease(BAD)and cerebral small vessel disease(CSVD)-related SSI.We applied the Beijing version of the Montreal Cognitive Assessment(MoCA-BJ),the Shape Trail Test(STT),and the Stroop Color and Word Test(SCWT)to investigate the differences in cognitive performance between these two subtypes of SSI.Methods:Patients with acute SSIs were prospectively enrolled.The differences of MoCA-BJ,STT,and SCWT between the BAD group and CSVD-related SSI group were analyzed.A generalized linear model was used to analyze the associations between SSI patients with different etiological mechanisms and cognitive function.We investigated the correlations between MoCA-BJ,STT,and SCWT using Spearman’s correlation analysis and established cut-off scores for Shape Trail Test A(STT-A)and STT-B to identify cognitive impairment in patients with SSI.Results:This study enrolled a total of 106 patients,including 49 and 57 patients with BAD and CSVD-related SSI,respectively.The BAD group performances were worse than those of the CSVD-related SSI group for STT-A(83[60.5-120.0]vs.68[49.0-86.5],P=0.01),STT-B(204[151.5-294.5]vs.153[126.5-212.5],P=0.015),and the number of correct answers on Stroop-C(46[41-49]vs.49[45-50],P=0.035).After adjusting for age,years of education,National Institutes of Health Stroke Scale and lesion location,the performance of SSI patients with different etiological mechanisms still differed significantly for STT-A and STT-B.Conclusions:BAD patients were more likely to perform worse than CSVD-related SSI patients in the domains of language,attention,executive function,and memory.The mechanism of cognitive impairment after BAD remains unclear.

Diagnostic Value of Cerebrospinal Fluid Sequencing for Neurosyphilis with Cognitive Impairment

Neurosyphilis(NS)is an infectious disease caused by Treponema pallidum invading the central nervous system.It can manifest at any stage of syphilis,and is often misdiagnosed due to its atypical and progressive symptoms.The increasing incidence of NS underscores the necessity for early and accurate diagnosis.Here,we present a case where routine cerebrospinal fluid metagenomic next-generation sequencing(mNGS)was used to diagnose a patient with neurosyphilis.The patient exhibited cognitive impairment and was initially diagnosed with cerebral infarction due to syphilitic cerebral arteritis.Thus,the patient was treated with dual antiplatelet therapy(aspirin and clopidogrel)and statins to stabilize the plaques.Neurosyphilis was treated with penicillin sodium injections,resulting in significant improvement in the patient’s mental state.This case is a rare instance of neurosyphilis associated with cerebral infarction.These findings suggest that mNGS is a valuable tool in diagnosing neurosyphilis,potentially improving diagnostic accuracy and patient outcomes.

醒脑开窍针刺法联合中药治疗脑梗死后轻度认知障碍的疗效观察

目的 观察醒脑开窍针刺法联合补肾益髓汤治疗脑梗死后轻度认知障碍的临床疗效。方法 将80例脑梗死后轻度认知障碍的患者随机分为研究组(40例)和对照组(40例)。两组均予基础治疗,研究组在基础治疗外另予醒脑开窍针刺法联合补肾益髓汤治疗。比较两组临床疗效,观察两组治疗前后简易精神状态检查表(mini-mental state examination,MMSE)、蒙特利尔认知评估(Montreal cognitive assessment,MoCA)和Rivermead行为记忆测验(Rivermead behavioural memory test,RBMT)的评分变化,观察两组治疗前后连线测验-B(trail making test-B,TMT-B)结果、血清淀粉样蛋白A(serum amyloid A,SAA)和β-淀粉样蛋白(amyloid β-protein,Aβ)水平以及脑微循环指标(颈总动脉的平均血流量、最大血流速度、最小血流速度、临界压力、脉搏速度、特性阻抗、外周阻力和动态阻力)的变化。结果 研究组总有效率高于对照组(P<0.05)。治疗后,两组MMSE、MoCA和RBMT评分均高于同组治疗前(P<0.05),且研究组上述评分均高于对照组(P<0.05)。治疗后,两组TMT-B结果以及SAA和Aβ水平均优于同组治疗前(P<0.05),且研究组上述指标优于对照组(P<0.05)。治疗后,两组脑微循环指标均较治疗前改善(P<0.05),且研究组优于对照组(P<0.05)。结论 在基础治疗以上,采用醒脑开窍针刺法联合补肾益髓汤治疗脑梗死后轻度认知障碍可提高临床疗效,能进一步改善患者认知功能,并调节SAA和Aβ水平。

血清小而密低密度脂蛋白胆固醇和总抗氧化能力水平与脑梗死患者认知功能障碍的相关性分析

目的:探究脑梗死患者血清小而密低密度脂蛋白胆固醇(small dense low-density lipoprotein cholesterol, sdLDL-C)和总抗氧化能力(total antioxidant capacity, T-AOC)水平变化及其与认知功能障碍发生的关系。方法:选择148例脑梗死患者,依据发病后7 d是否出现认知功能障碍,分为非障碍组(n=77)和障碍组(n=71);分别采用过氧化氢酶法和比色法测定两组血清sdLDL-C和T-AOC水平,并进行比较;Pearson相关系数法分析脑梗死患者血清sdLDL-C、T-AOC水平与蒙特利尔认知评估(MoCA)评分相关性;二元Logistic回归分析影响脑梗死患者认知功能障碍发生的危险因素。结果:与非障碍组相比,障碍组血清sdLDL-C水平明显升高(P<0.05),T-AOC水平明显降低(P<0.05)。相关性分析显示,血清sdLDL-C水平与MoCA评分呈负相关(r=-0.516,P<0.05),T-AOC水平与MoCA评分呈正相关(r=0.446,P<0.05)。Logistic回归分析显示,高血压、糖尿病、病情严重程度、血清sdLDL-C和T-AOC是脑梗死患者认知功能障碍发生的独立影响因素(P<0.05)。结论:脑梗死患者血清sdLDL-C水平升高,T-AOC水平降低,二者是影响脑梗死患者并发认知功能障碍的独立影响因素。

脑梗死患者认知障碍与脑白质病变相关性分析

目的探讨脑梗死(CI)患者认知障碍与脑白质病变(WML)的相关性,基于多因素logistic回归分析认知障碍并发WML的危险因素。方法选取2020年8月至2022年10月医院收治的134例CI患者为研究对象,依据是否发生认知障碍分为发生组(56例)、未发生组(78例)。比较两组一般资料,分析认知障碍与年龄相关性脑白质改变评分(ARWMC)相关性。发生组患者依据是否发生WML病变分为非病变者36例、病变者20例,并分析WML病变者、非病变者血清学指标[视黄醇结合蛋白(RBP)、半乳糖凝集素-3(Galectin-3)、白细胞介素-33(IL-33)]水平。多因素logistic回归分析认知障碍并发WML的危险因素。评价危险因素联合预测认知障碍并发WML的预测价值。结果CI患者认知障碍与入院时ARWMC评分存在线性关系(P=0.005),且认知障碍与入院时ARWMC评分呈正相关(r=0.485,P<0.001)。病变者年龄、入院时NIHSS评分、重度颈动脉狭窄占比、多梗死灶占比高于非病变者,血清RBP、Galectin-3、IL-33水平高于非病变者(P<0.05)。高龄、入院时NIHSS评分增加、颈动脉狭窄程度加重、多梗死灶及血清RBP、Galectin-3、IL-33水平升高均为认知障碍并发WML的危险因素(P<0.05)。危险因素联合预测认知障碍并发WML的曲线下面积大于血清RBP、Galectin-3、IL-33单独预测(P<0.05)。结论CI患者认知障碍与WML呈正相关,年龄增长、入院时NIHSS评分增加、颈动脉狭窄程度增加、多梗死灶及血清RBP、Galectin-3、IL-33水平升高是影响认知障碍并发WML的危险因素,基于危险因素建立logistic回归预测模型,该模型对认知障碍并发WML具有一定预测价值。

补阳还五汤治疗脑梗死恢复期患者的临床疗效

目的:探究补阳还五汤治疗脑梗死恢复期患者的临床疗效。方法:按照治疗药物不同将84例气虚血瘀型脑梗死恢复期患者分为中药组和常规组,每组各42例。常规组采用常规药物治疗;中药组联合补阳还五汤辅助治疗。比较两组治疗前、治疗4周后的中医症候积分、神经功能、认知功能、肢体运动能力。结果:治疗4周后,两组患者中医症候积分各维度及总分、血清超敏C反应蛋白(hs-CRP)、血栓调节蛋白(TM)水平均低于治疗前,且中药组低于常规组(P<0.05);两组患者血清脱氢表雄酮(DHEA)、脑源性神经营养因子(BDNF)水平、蒙特利尔认知评估量表(MoCA)评分、Fugl-Meyer运动功能评分(FMA)均较治疗前升高(P<0.05),且中药组高于常规组(P<0.05);血清VEGF水平较治疗前降低(P<0.05),但中药组高于常规组(P<0.05)。结论:补阳还五汤可有效改善脑梗死恢复期患者临床症状,提高DHEA、BDNF水平和认知功能,促进肢体运动恢复。

交叉性小脑神经机能联系不能1例报道并文献复习

交叉性小脑神经机能联系不能(crossed cerebellar diaschisis,CCD)是指当一侧大脑半球发生病变时,病灶对侧小脑半球出现血流量减少、葡萄糖氧化代谢水平下降的功能障碍,严重时甚至可能出现交叉性小脑萎缩的现象。CCD在临床工作中易被忽略或误诊。本文报告1例因左侧幕上脑梗死出现CCD导致左侧肢体共济失调以及认知功能障碍加重的病例,通过文献综述,阐明CCD的发生机制、临床特点及影响因素,为临床提供借鉴。