关键词: 脑白质病变; 脑白质疏松; 认知功能; 蒙特利尔认知评估; 阈值效应

Abstract:

Objective To explore the characteristics of cognitive function in the patients with different locations of lesions and severity degrees of white matter lesions (WMLs). Methods A total of 179 WMLs cases and 97 normal brain magnetic resonance imaging (MRI) control cases were included prospectively and demographic information was collected. According to the locations of lesions, WMLs were classified into 3 subgroups: subcortical white matter lesions (SWML), periventricular lesions (PVL) group and mixed legions group. Fazekas visual ratings were administered to evaluate the severity of WMLs. Montreal Cognitive Assessment Scale (MoCA) was used to evaluate the cognitive function differences among different locations of lesions and severity degrees of WMLs. According to MoCA, WMLs group can be divided into subgroups WMLs cognitive impairment (116 cases) and the WMLs cognitively normal group (63 cases). The analysis of risk factors for cognitive impairment of patients with WMLs was performed and discussed. Results Total MoCA scores (P ﹤0.001), visual space execution ability (P ﹤0.001), named (P =0.019), language (P =0.005), abstract understanding (P =0.003) and delayed memory (P ﹤0.001) of WMLs group was significantly lower than those of control groups, respectively. The higher Fazekas classification, the significantly lower MoCA scores and the scores of all items (P ﹤0.05). Compared with control group, the MoCA scores (all P ﹤0.001), visual space execution ability (P ﹤0.001), language (P =0.006, 0.022, 0.008), abstract understanding (P =0.003, 0.011, 0.016) and delayedmemory (all P ﹤0.001) of PVL group, the SWML group and mixed group had significant statistical differences. WMLs subgroup analysis showed that the high level of education was a protection factor for cognitive impairment WMLs. Conclusion High education is the protection factor for cognitive impairment in WMLs patients. The visual space execution ability, delayed memory are more obviously impaired in WMLs patients. The higher severity level of WMLs lesions, the more distinct decrease of the cognitive function. SWML WMLs, PVL WMLs and mixed groups have severe damage in the visual space and execution ability, language, abstract understanding, and delayed memory.

Key words: White matter lesion; Leukoaraiosis; Cognitive impairment; Montreal Cognitive
Assessment; Threshold effect