Effect of Cognitive Reserve on the Integrity of White Matter Tracts in Patients with White Matter Hyperintensities at Different Cognitive Stage

doi:10.3969/j.issn.1673-5765.2022.05.013

Abstract

Abstract: Objective To investigate the effect of cognitive reserve (CR) on the integrity of white matter tracts in patients with white matter hyperintensities (WMH) across different cognitive stages. Methods This study prospectively enrolled the consecutive patients with WMH who were admitted in Department of Neurology, Nanjing Drum Tower Hospital from January 2017 to December 2020. All subjects underwent neuropsychological tests, cognitive reserve assessment and multimodal MRI scans. According to the MoCA score, the patients were divided into WMH with cognitive impairment (CI) group (WMH-CI) and WMH without CI group (WMH-nonCI). According to the median cognitive reserve index (CRI), the patients were further divided into WMH-CI high CR group, WMH-CI low CR group, WMH-nonCI high CR group and WMH-nonCI low CR group. The integrity of white matter tracts was measured by the fractional anisotropy (FA), a diffusion parameter of white matter tracts, which was calculated by PANDA software. The two-factor ANOVA was used to analyze the effects of cognitive status and CR level on cognitive function, brain volume and FA value of white matter tracts, and the correlation analysis of cognitive function, brain volume and FA value was performed. Results A total of 137 patients with WMH were included, including 39 subjects with WMHnonCI and low CR, 42 with WMH-nonCI and high CR, 35 with WMH-CI and low CR, and 21 with WMH-CI and high CR. The scores of MMSE (F =5.872, P =0.017), MoCA (F =19.310, P <0.001), executive function (F =4.329, P =0.039) and processing speed (F =15.136, P <0.001) in patients with high CR were significantly higher than those in patients with low CR. Cognitive status and CR level had an interactive effect in the FA in the left uncinate tract (F =4.324, P =0.040). For patients without CI, there was no statistical difference in FA value between the low CR group and high CR group (t =−0.138, P =0.891); while for patients with CI, the FA in high CR group was significantly lower than that in low CR group (t =2.999, P =0.004). Cognitive status and CR level had an interaction effect in gray matter volume (F =4.949, P =0.028). In addition, both the FA in the left uncinate tract (r =0.368, P =0.003) and gray matter volume (r =0.292, P =0.020) were significantly positively correlated with MoCA in patients with high CR. Conclusions In patients with WMH and normal cognitive function, there was no correlation between CR level and the integrity of white matter tracts. Whereas for patients with WMH and CI, the integrity of white matter tracts was significantly decreased in those with high CR and correlated with cognitive function.

Key words: Cognitive reserve; White matter hyperintensity; Cognitive impairment; Diffusion tensor imaging

摘要：

目的探讨认知储备（cognitive reserve，CR）对不同认知阶段脑白质高信号（white matter hyperintensity， WMH）患者白质纤维束完整性的影响。

方法课题组于2017年1月-2020年12月在南京鼓楼医院神经内科前瞻性连续入组WMH患者。所有受试者均进行多维度神经心理测试、认知储备评估和多模态MRI扫描。根据MoCA评分将WMH患者分为WMH伴认知障碍（cognitive impairment，CI）组及WMH不伴CI组，根据认知储备指数（cognitive reserve index，CRI）中位数进一步分为WMH-CI 高CR组、WMH-CI 低CR组、WMH-nonCI高CR组与WMH-nonCI低CR组。利用PANDA软件计算出白质纤维束弥散参数各向异性分数（fractional anisotropy，FA）衡量白质纤维束完整性。采用双因素方差分析法研究认知状态和CR水平对认知功能、脑体积和白质纤维束FA值的影响，并开展认知功能、脑体积和FA值的关联分析。

结果共纳入137例WMH患者，包括WMH-nonCI低CR组39例、WMH-nonCI高CR组42例、WMH-CI低CR组35例和WMH-CI高CR组21例。高CR受试者MMSE评分（F =5.872，P =0.017）、MoCA评分（F =19.310， P ＜0.001）、执行功能（F =4.329，P =0.039）和处理速度（F =15.136，P ＜0.001）的评分均高于低 CR者。认知状态和CR水平在左侧钩状束的FA值存在交互效应（F =4.324，P =0.040）：在无CI 患者中，高CR与低CR组的FA值差异无统计学意义（t =-0.138，P =0.891）；在CI患者中，高CR组FA值低于低CR组（t =2.999，P =0.004）。认知状态和CR水平在灰质体积上存在交互效应（F =4.949， P =0.028）。此外，高CR者的左侧钩状束FA值（r =0.368，P =0.003）和脑灰质体积（r =0.292， P =0.020）均与MoCA评分呈正相关。

结论在认知正常的WMH患者中，CR水平与白质纤维束完整性无相关性；而在合并CI的WMH患者中，高CR患者的白质纤维束完整性显著下降，且与认知水平显著相关。

关键词: 认知储备; 脑白质高信号; 认知功能障碍; 弥散张量成像

ZHU Huahong, YE Qing, QIN Ruomeng, HUANG Lili, XU Yun. Effect of Cognitive Reserve on the Integrity of White Matter Tracts in Patients with White Matter Hyperintensities at Different Cognitive Stage[J]. Chinese Journal of Stroke, 2022, 17(05): 516-522.

朱化红, 叶青, 秦若梦, 黄丽丽, 徐运. 认知储备对不同认知阶段脑白质高信号人群脑白质纤维束完整性的影响[J]. 中国卒中杂志, 2022, 17(05): 516-522.

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