Relationship of cerebral arterial stenosis to cognitive and memory disorders

BACKGROUND: Cerebral arterial stenosis can cause cerebral hypoperfusion, and than result in the decline of cognitive function, whereas the cognitive dysfunction induced by different cerebral arterial stenosis have different manifestations and types. OBJECTIVE: To observe the differences of cognitive and memory dysfunctions in patients with cerebral arterial stenosis of different types. DESIGN: A comparative observation. SETTING: Affiliated Hospital of Jining Medical College. PARTICIPANTS: Forty-two outpatients or inpatients with cerebral arterial stenosis were selected from the Department of Neurology, Affiliated Hospital of Jining Medical College from February 2005 to January 2006, including 25 males and 17 females. There were 18 cases of internal carotid arterial stenosis, 14 cases of vertebrobasilar arterial stenosis and 10 cases of whole cerebral arterial stenosis. The diagnostic standards for cerebral arterial stenosis were identified according to North American Symptomatic Carotid Endarterectomy Trial (NASCET). Meanwhile, 18 healthy physical examinees were enrolled as the control group, including 10 males and 8 females, aged 58-80 years old. All the enrolled subjects were informed and agreed with the detection and evaluation. METHODS: ① The memory function was evaluated using revised Wechsler memory scale for adults, including long-term memory (experience, orientation and counting), short-term memory (visual recognition, picture memory, visual regeneration, association and thigmesthesia) and sensory memory (forward and backward recitation of numbers). The scale scores were turned to memory quotients. The higher the scores, the better the memory function. ② The cognitive function was evaluated using revised Wechsler adult intelligence scale: It consisted of eleven subtests, including six language scales (information, digit span, vocabulary, arithmetics, apprehension, similarity) and five operation scales (picture completion, picture arrangement, block design, geometric design, digit-symbol test). The intelligence quotients were obtained. The higher the scores, the better the cognitive function. MAIN OUTCOME MEASURES: Results of memory and cognitive function test in patients with cerebral arterial stenosis of different types. RESULTS: All the 42 patients with cerebral artery stenosis and 11 healthy subjects were involved in the final analysis of results. ① Results of memory function test: The memory function was worse in the arterial stensis groups than in the control group (P < 0.05-0.01). There were very significant differences in the scores of orientation, association and picture memory between the internal carotid arterial stenosis group and control group (P < 0.01). There were also very significant differences in the scores of counting, logic memory, forward and backward recitation of numbers, visual regeneration, visual recognition and thigmesthesia between the vertebrobasilar arterial stenosis group and control group (P < 0.01). Except experience and visual regeneration, there were significant very differences in the scores of the other tests between the whole cerebral arterial stenosis group and control group (P < 0.01). The memory quotient was obviously lower in the vertebrobasilar arterial stenosis group than in the internal carotid arterial stenosis group [(72.31±26.46), (87.38±21.86) points, P < 0.05], and it was the lowest in the whole cerebral arterial stenosis group [(63.74±25.25) points]. ② Results of cognitive function test: The cognitive function was worse in the arterial stensis groups than in the control group (P < 0.05-0.01). There were very significant differences in the scores of apprehension, arithmetics, similarity, digit-symbol test, picture completion and block design between the internal carotid arterial stenosis group and control group (P < 0.01). There were also very significant differences in the scores of backward recitation of numbers, vocabulary and geometric design between the vertebrobasilar arterial stenosis group and control group (P < 0.01). Except information, there were significant very differences in the scores of the other tests between the whole cerebral arterial stenosis group and control group (P < 0.01). The intelligence quotient was obviously lower in the internal carotid arterial stenosis group than in the vertebrobasilar arterial stenosis group [(72.65±23.39), (81.34±25.46) points, P < 0.05], and it was the lowest in the whole cerebral arterial stenosis group [(65.98±27.34) points]. CONCLUSION: Different cerebral arterial stenosis can induce different cognitive dysfunctions. The main manifestation of the patients with internal carotid arterial stenosis was the declined cognitive function, and that in patients with vertebrobasilar arterial stenosis was the declined memory, and the decrease of total intelligence was more obvious in the formers than in the latters, whereas the decrease of total memory quotient was more obvious in the patients with vertebrobasilar arterial stenosis; The cognitive and memory dysfunction were the most serious in patients with whole cerebral arterial stenosis.

The potential mechanism and clinical application value of remote ischemic conditioning in stroke

Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may be related to neuroinflammation, cellular immunity, apoptosis, and autophagy, the exact underlying molecular mechanisms are unclear. This review summarizes the current status of different types of remote ischemic conditioning methods in animal and clinical studies and analyzes their commonalities and differences in neuroprotective mechanisms and signaling pathways. Remote ischemic conditioning has emerged as a potential therapeutic approach for improving stroke-induced brain injury owing to its simplicity, non-invasiveness, safety, and patient tolerability. Different forms of remote ischemic conditioning exhibit distinct intervention patterns, timing, and application range. Mechanistically, remote ischemic conditioning can exert neuroprotective effects by activating the Notch1/phosphatidylinositol 3-kinase/Akt signaling pathway, improving cerebral perfusion, suppressing neuroinflammation, inhibiting cell apoptosis, activating autophagy, and promoting neural regeneration. While remote ischemic conditioning has shown potential in improving stroke outcomes, its full clinical translation has not yet been achieved.

The multiple effects of hyperhomocysteinemia in patients with mildto- moderate stroke

Background:The main purpose of this article is to explore the differences between mild-to-moderate acute stroke patients with hyperhomocysteine and similar patients with normal homocysteine in risk factors,cerebral arterial stenosis,neurological deficit,cognitive function impairment.The subjects included gender,body mass index,whether to combine hypertension,blood glucose level,blood lipid,national institutes of health stroke scale(NIHSS)score,whether to combine cerebral arterial stenosis and Montreal cognitive assessment scores.Method:Twentyseven mild-to-moderate acute stroke patients with hyperhomocysteinemia(NIHSS score≤15 points)and 34 mildto-moderate acute stroke patients without hyperhomocysteinemia were admitted in the past year as the research objects.N=27 stroke patients with hyperhomocysteine were set as the experimental group,and N=34 patients without hyperhomocysteine were set as the control group.A retrospective study of clinical data from both groups of patients was conducted.Compare the data of the 2 groups of patients with differences in the above study data,and then explore the specific impact of hyperhomocysteinemia on the above experimental indicators.Results:(1)NIHSS scores of patients in the experimental group were higher than those in the control group,and the difference was statistically significant(P<0.05).(2)The incidence of cerebrovascular stenosis(including intracranial and extracranial arteries)in the experimental group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).(3)The degree of cognitive impairment in the experimental group was significantly higher than that in the control group,with a statistically significant difference(P<0.05).(4)The proportion of male patients in the study group was significantly higher than that in the control group(P<0.05).(5)The level of homocysteine in the experimental group was positively correlated with NIHSS score(r=0.602,P<0.05)and negatively correlated with Montreal cognitive assessment score(r=−0.551,P<0.05).Conclusion:Mildto-moderate stroke patients with hyperhomocysteinemia are more likely to have severe neurological deficits,and most patients will be associated with more severe intracranial arterial and extracranial arterial stenosis.Mild-tomoderate stroke patients with high homocysteine are more likely to develop cognitive impairment.Finally,high homocysteine levels were associated with neurological impairment and cognitive impairment.Therefore,clinically,patients with acute stroke and hyperhomocysteinemia should be actively treated with hypohomocysteine,and it is recommended to improve cerebrovascular evaluation(computed tomography angiography or magnetic resonance angiography)for hospitalized patients even with hemorrhagic stroke.Stroke patients with hyperhomocysteinemia should be given more aggressive treatment(ischemic stroke patients should be given more optimized antithrombotic therapy,hemorrhagic stroke patients should be given more aggressive dehydrating cranial pressure reduction,et al.).Finally,brain protectants and cognitive function improvement therapy can be given in advance to prevent cognitive function deterioration.

Cerebral vasculopathy in a Chinese family with neurofibromatosis type Ⅰ mutation

Neurofibromatosis type I（NF1） is a hereditary,autosomal dominant,neurocutaneous syndrome that is attributed to NF1 gene mutation.NF1 has been associated with scoliosis,macrocephaly,pseudoarthrosis,short stature,mental retardation,and malignancies.NF1-associated vasculopathy is an uncommon and easily-overlooked presentation.Examination of a Chinese family affected by NF1 combined with cerebral vessel stenosis and/ or abnormality suggested a possible relationship between NF1 and vessel stenosis.To determine which NF1 gene mutation is associated with vascular lesions,particularly cerebral vessel stenosis,we examined one rare family with combined cerebral vessel lesions or maldevelopment.Vascular lesions were detected using transcranial Doppler sonography and digital subtraction angiography in family members.Next,denaturing high-performance liquid chromatography and sequencing were used to screen for NF1 gene mutations.The results revealed a nonsense mutation,c.541C＆gt;T,in the NF1 gene.This mutation truncated the NF1 protein by 2659 aminoacid residues at the C-terminus and co-segregated with all of the patients,but was not present in unaffected individuals in the family.Exceptionally,three novel mutations were identified in unaffected family members,but these did not affect the product of the NF1 gene.Thus the nonsense mutation,c.541C＆gt;T,located in the NF1 gene could constitute one genetic factor for cerebral vessel lesions.