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Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Contribution of Inflammation and Hypoperfusion to White Matter Hyperintensities-Related Cognitive Impairment
Chao-Juan Huang1, Xia Zhou1, Xin Yuan1
1Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China.
Abstract:
White matter hyperintensities (WMHs) of presumed vascular origin are one of the most important neuroimaging markers of cerebral small vessel disease (CSVD), which are closely associated with cognitive impairment. The aim of this study was to elucidate the pathogenesis of WMHs from the perspective of inflammation and hypoperfusion mechanisms. A total of 65 patients with WMHs and 65 healthy controls were enrolled in this study. Inflammatory markers measurements [hypersensitive C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2)], cognitive evaluation, and pseudocontinuous arterial spin labeling (PCASL) MRI scanning were performed in all the subjects. The multivariate logistic regression analysis showed that Lp-PLA2 was an independent risk factor for WMHs. Cerebral blood flow (CBF) in the whole brain, gray matter (GM), white matter (WM), left orbital medial frontal gyrus [MFG.L (orbital part)], left middle temporal gyrus (MTG.L), and right thalamus (Tha.R) in the patients was lower than those in the controls and CBF in the left triangular inferior frontal gyrus [IFG.L (triangular part)] was higher in the patients than in the controls. There was a significant correlation between Lp-PLA2 levels and CBF in the whole brain (R = -0.417, p < 0.001) and GM (R = -0.278, p = 0.025), but not in the WM in the patients. Moreover, CBF in the MFG.L (orbital part) and the Tha.R was, respectively, negatively associated with the trail making test (TMT) and the Stroop color word test (SCWT), suggesting the higher CBF, the better executive function. The CBF in the IFG.L (triangular part) was negatively correlated with attention scores in the Cambridge Cognitive Examination-Chinese Version (CAMCOG-C) subitems (R = -0.288, p = 0.020). Our results revealed the vascular inflammation roles in WMHs, which may through the regulation of CBF in the whole brain and GM. Additionally, CBF changes in different brain regions may imply a potential role in the modulation of cognitive function in different domains.
Insights
Inflammation marker Lp-PLA2 is a risk factor for white matter hyperintensities (WMHs). Reduced cerebral blood flow (CBF) in WMH patients is linked to cognitive deficits, suggesting vascular inflammation impacts brain health and cognition.
Area of Science:
- Neuroimaging
- Vascular Biology
- Cognitive Neuroscience
Background:
- White matter hyperintensities (WMHs) are key neuroimaging markers of cerebral small vessel disease (CSVD).
- WMHs are strongly associated with cognitive impairment.
- The pathogenesis of WMHs involving inflammation and hypoperfusion requires further elucidation.
Purpose of the Study:
- To investigate the role of inflammation and hypoperfusion in the pathogenesis of white matter hyperintensities (WMHs).
- To explore the relationship between inflammatory markers, cerebral blood flow (CBF), and cognitive function in patients with WMHs.
Main Methods:
- Recruited 65 patients with WMHs and 65 healthy controls.
- Measured inflammatory markers (hsCRP, Lp-PLA2), cognitive function, and performed pseudocontinuous arterial spin labeling (PCASL) MRI.
- Utilized multivariate logistic regression and correlation analyses.
Main Results:
- Lipoprotein-associated phospholipase A2 (Lp-PLA2) was identified as an independent risk factor for WMHs.
- Patients with WMHs exhibited lower whole-brain, gray matter, and white matter CBF compared to controls, with specific regional differences.
- Lp-PLA2 levels correlated negatively with whole-brain and gray matter CBF; regional CBF changes were associated with executive function and attention.
Conclusions:
- Vascular inflammation, indicated by Lp-PLA2, plays a role in WMHs, potentially by regulating CBF in the whole brain and gray matter.
- Altered CBF in specific brain regions may be implicated in the modulation of cognitive functions.
- These findings highlight the link between vascular inflammation, hypoperfusion, and cognitive decline in CSVD.
