Assessing cognitive impairment in epilepsy using Arterial spin-labeled (ASL) perfusion imaging

To investigate differences in cerebral blood flow (CBF) between people with epilepsy (PWE) who had cognitive impairment and those who did not, and to explore the association between cerebral perfusion abnormalities and cognitive dysfunction. A total of 89 patients who attended the epilepsy outpatient clinic of the Department of Neurology, General Hospital of Ningxia Medical University, between January 2021 and September 2025 were retrospectively included.Demographic and clinical data were collected. Cognitive function, sleep quality, anxiety, and depression were assessed using the Mini-Mental State Examination (MMSE), Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS). Patients were classified into cognitive impairment and non-cognitive impairment groups according to their MMSE scores. CBF was assessed using a region-of-interest (ROI)-based approach, and intergroup differences in perfusion were analyzed. Compared with PWE without cognitive impairment,patients with cognitive impairment showed reduced cerebral perfusion in multiple brain regions.Specifically, significantly lower perfusion was observed in the bilateral insula, bilateral caudate nucleus, and left lentiform nucleus (all P< 0.05). Reduced cerebral perfusion in specific brain regions may be associated with cognitive impairment in PWE.