Development and validation of a nomogram for identifying cognitive impairment in patients with leukoaraiosis

Leukoaraiosis (LA) is a common cerebral small vessel disease in elderly populations that frequently leads to cognitive impairment and may progress to vascular dementia. Early identification of cognitive dysfunction remains challenging due to the subtle onset and lack of specific biomarkers.

To identify key factors associated with cognitive impairment in LA patients and develop a logistic regression-based identification model to facilitate early clinical recognition and intervention.

This retrospective cross-sectional study included 390 LA patients admitted to the Department of Neurology between June 2020 and April 2023. Patients were classified into cognitive impairment (CI) and non-cognitive impairment (NCI) groups based on Montreal Cognitive Assessment (MoCA) scores. Data collected included demographics, medical history, biochemical markers, and neuroimaging features. The dataset was randomly split 7:3 into training (n = 273) and validation (n = 117) sets. Univariate analysis identified significant variables (p < 0.05), which were then incorporated into multivariate logistic regression analysis. A nomogram was constructed based on the final model, and performance was evaluated using receiver operating characteristic (ROC) curves and calibration plots for both training and validation sets.

In the training set of 273 patients, 137 had cognitive impairment and 136 did not. Univariate analysis revealed that age, Fazekas score, intracranial arterial stenosis assessment (IASA), serum creatinine, and total bilirubin were significantly associated with cognitive impairment (p < 0.05). Multivariate logistic regression identified age (OR = 1.17, 95%CI: 1.11-1.24), IASA (OR = 2.52, 95%CI: 1.64-3.68), and Fazekas score (OR = 2.58, 95%CI: 1.74-3.60) as independently associated factors. The logistic regression model demonstrated excellent discrimination with AUC values of 0.873 and 0.814 for training and validation sets, respectively. Calibration curves showed good agreement between predicted and observed probabilities, confirming model reliability.

Age, intracranial arterial stenosis assessment, and Fazekas score are independently associated with cognitive impairment in LA patients. The logistic regression model with nomogram provides a clinically practical tool for identifying and stratifying patients with cognitive impairment, facilitating targeted clinical assessment and intervention.