Abstract: Objective Subcortical ischemic vascular disease (SIVD), characterised by multiple lacunar infarcts and white matter lesion (WML), has been considered as a major cause of subcortical vascular cognitive impairment (SVCI). The objective of the study is to identify the risk factors for SVCI in a group of SIVD patients who were registered in a stroke secondary prevention clinic. Methods Based on the detailed neuropsychological investigation and clinical interview, 61 cases that met the criteria of SIVD were recruited and classified as 3 groups of different cognitive state: no cognitive impairment (NCI), vascular cognitive impairment no dementia (VCI-ND) and vascular dementia (VaD). The latter two were further grouped as vascular cognitive impairment (VCI). Their demographic data, vascular risk factors and neuroimaging information were documented. Results 1) The total prevalence of VCI (VCI-ND and VaD) was 63.93% (39/61). The prevalence of VCI-ND and VaD were 36.07% (22/61) and 27.87% (17/61), respectively. 2) There were significant differences of age and educational years among NCI, VCI-ND and VaD groups (P = 0.032, 0.019). Paired comparison showed that VaD patients were older and less educated than NCI patients (P = 0.029, 0.022). The age difference between NCI and VCI groups nearly approached statistical significance (t = 3.740, P = 0.058), while the year of education of VCI was significantly lower than that of NCI (t = 7.888, P = 0.007). 3) There were significant differences of diabetes mellitus (DM) cases among NCI, VCI-ND and VaD groups (P = 0.037). There were more DM cases in VCI group than those in NCI group (P = 0.012), but no significant statistical difference was found among other vascular risk factors. 4) There was no difference of lacunar infarcts in different site of subcortical grey matter among these groups, respectively (P > 0.05, for all). Significant differences of subcortical white matter infarcts, WML scores and medial temporal atrophy (MTA) scores were found in patients in NCI, VCI-ND and VaD group (P = 0.020, 0.001, 0.000). The number of lacunar infarcts within white matter in VaD group was higher than that in NCI group (P = 0.027). The WML scores of VaD was much higher than that of VCI-ND and NCI (P = 0.001, 0.017). The MTA scores of VaD patients was much higher than that of VCI-ND and NCI patients (P = 0.001, 0.000). The number of white matter lacunar infarcts, the WML scores and the MTA scores of VCI was much higher than that of NCI (t = -2.661, P = 0.003; t = -2.953, P = 0.005; t = -4.712, P = 0.000). 5) Logistic regression showed that DM, the number of white matter infarcts and MTA scores were independent risk factors for SVCI. Conclusion SVCI is common in SIVD patients and related to DM, ischemic and degenerative injuries of the brain.

Key words: Dementia, vascular, Cognition disorders, Neuropsychological tests

摘要： 目的   分析皮质下血管性认知损害的相关影响因素。方法   61 例符合皮质下缺血性血管病诊断标准患者，经详细的神经心理学测验和临床访谈分为无认知损害组、非痴呆型血管性认知损害组和血管性痴呆组，后两组进一步合并为血管性认知损害组；登记并分析所有患者的社会人口学、血管性危险因素和影像学资料。结果   血管性认知损害总患病率为63.93%（39/61），其中非痴呆型血管性认知损害和血管性痴呆患病率分别为36.07%（22/61）和27.87%（17/61）。单因素分析显示：（1）年龄和受教育程度因素比较，血管性痴呆组年龄高于无认知损害组（P = 0.029），而受教育程度低于无认知损害组（P = 0.022）；血管性认知损害组（包括非痴呆型血管性认知损害组和血管性痴呆组）与无认知损害组受试者之间的年龄差异接近统计学意义（t = 3.740，P = 0.058），但受教育程度低于无认知损害组（t = 7.888，P = 0.007）。（2）血管性认知损害组糖尿病患病率显著高于无认知损害组（P = 0.012）。（3）皮质下灰质各部位腔隙性梗死灶数目，组间比较差异无统计学意义（均P > 0.05）；血管性痴呆组白质梗死灶数目高于无认知损害组（P = 0.027），脑白质病变评分高于非痴呆型血管性认知损害组（P = 0.001）和无认知损害组（P = 0.017），内侧颞叶萎缩评分高于非痴呆型血管性认知损害组（P = 0.001）和无认知损害组（P =0.000）；血管性认知损害组白质梗死灶数目、脑白质病变评分和内侧颞叶萎缩评分均高于无认知损害组（t = -2.661，P = 0.003；t = -2.953，P = 0.005；t = -4.712，P = 0.000）。多因素分析，糖尿病、脑白质梗死和内侧颞叶萎缩同为皮质下血管性认知损害的独立危险因素。结论   皮质下血管性认知损害常见于皮质下缺血性血管病患者，与糖尿病、脑缺血性损伤和退行性变等多种因素有关。

关键词: 痴呆, 血管性, 认知障碍, 神经心理学测验