Name: evaluation of the cognitive performance of hypertensive patients with silent cerebrovascular lesions
Uploaded: 2021-04-23T12:30:00
Description: Watch this Scientific Journal Video about Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions at JoVE.com

This work was supported by matching and donation funds (Cerebrovascular Research Fund, SHAC Matching Grant, UGC Matching Grant, and Dr. William Mong Research Fund in Neurology awarded to Professor R.T.F. Cheung).

The study protocol was approved by the Institutional Review Board of the University of Hong Kong / Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB) for human research.
1. Participants
<ol>
	<li>Recruit otherwise healthy elderly Chinese subjects (from 65 to 99 years old, mean age 72) with a history of hypertension for at least 5 years.</li>
	<li>Exclude participants with any disease affecting the cognitive function and/or with any disability hindering the completion of the required ...

<ol>
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In the study, we have combined the results of a battery of neuropsychological assessment and findings of a multi-sequence MRI examination to evaluate the impact of different types of SCLs on various cognitive functions. The major types of SCLs were examined (i.e., CMBs, SLs and WMHs). As previous studies have revealed that SCLs in different locations may represent different pathology and lead to different consequences, we categorized CMBs and SLs into strictly lobar (i.e., lobar only without deep ones) and deep ones (wit...

Silent lacunes (SLs), cerebral microbleeds (CMBs) and white matter hyperintensities (WMHs) are referred to as silent cerebrovascular lesions (SCLs). Two types of WMHs are recognized: periventricular WMHs (PVHs) and deep WMHs (DWMHs). SCLs were once regarded as benign lesions without clinical significance. After decades of research, SCLs are now confirmed to be linked to varying functional impairment and cognitive deficits1,2. Nevertheless, consistent evidence is still limited in the spectrum and magnitude of cognitive effects of different types of SCLs. Moreover, the underlying mechanisms are elusive.
Most previous studies either recruited hospital patients with severe medical conditions3,4,5 or included participants with advanced cerebral small vessel diseases6,7. The heterogeneity of the participants among different studies has partly contributed to the inconsistent results. To exclude these confounding factors, we conducted the current one-centered&#160;study as an attempt to provide a clear picture through assessment of a relatively large, pure cohort recruited from a primary care setting. Furthermore, previous studies have predominantly focused on one or two types of SCLs and did not fully evaluate the independent associations between individual SCLs and specific cognitive functions. Therefore, we assessed various types of SCLs in the current study.
Neuropsychological tests are widely used to assess cognitive function of specific domains. They are useful in differentiation between normal aging and early cognitive impairment. Results of properly conducted neuropsychological assessment are sensitive in discerning behavioral and functional deficits. A battery of structured neuropsychological tests was chosen, including forward and backward digit span tests, symbol digit modalities test (SDMT), Stroop test, verbal fluency test and Montreal Cognitive Assessment (MoCA). Scores from these tests were grouped and combined to represent performance in different cognitive domains8,9. Such a method is widely used and is time efficient. A major drawback is that different neuropsychological tests may partly overlap in their tested domains. A more specific alternative is to use computer-based assessment with well-designed modules constructed using the E-Prime system, which is time-consuming and may not be suitable for screening purposes.
In conclusion, we aimed to assess the associations between the burden of different SCLs and impairment of various cognitive domains. Furthermore, vascular risk factors and other types of SCLs were controlled for to determine the distinct and independent profile&#160;of cognitive impairment of each type of SCLs.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>3T MRI</td>
			<td>Philips Medical Systems</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

evaluation of the cognitive performance of hypertensive patients with silent cerebrovascular lesions

Evidence accumulated from the last decade has proven that silent cerebrovascular lesions (SCLs) and their underlying pathogenic processes contribute to cognitive decline in the elderly. However, the distinct effects of each type of the lesions on cognitive performance remain unclear. Moreover, research data from Chinese elderly with SCLs is scarce. In this study, 398 otherwise healthy hypertensive elderly subjects (median age 72 years) were included and assessed. All participates were required to complete a battery of structured neuropsychological assessment, including forward and backward digit span tests, symbol digit modalities test, Stroop test, verbal fluency test and Montreal Cognitive Assessment. These tests were used to assess attention, executive function, information processing speed, language, memory and visuospatial function. A multi-sequence 3T MRI scanning was arranged within one month of the neuropsychological assessment to evaluate the burden of SCLs. SCLs were rated visually. Cerebral microbleeds (CMBs) and silent lacunes (SLs) were identified as strictly lobar CMBs and SLs or deep CMBs and SLs according to their locations, respectively. Similarly, white matter hyperintensities (WMHs) were separated into periventricular WMHs (PVHs) and deep WMHs (DWMHs). A series of linear regression models were used to assess the correlation between each type of SCLs and individual cognitive function domain. The results showed that CMBs tend to impair language-related cognition. Deep SLs affect executive function, but this association disappeared after controlling for other types of SCLs. PVHs, rather than DWMHs, are associated with cognitive decline, especially in executive function and processing speed. It is concluded that different aspects of SCLs have differential impact on cognitive performance in hypertensive elderly Chinese.

The mean age of the 398 participants was 72.0 (from 65 to 99, SD = 5.1) years, and there were 213 men (53. 5%; Table 3). Table 4 summarizes the neuropsychological assessment results. Only 5 participants had all four types of SCLs. One or more types of SCLs were found in 169 (42.5%) participants, and 35 (8.8%) and 17 (4.3%) participants had 2 and 3 types of SCLs, respectively (Table 5).
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Watch this Scientific Journal Video about Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions at JoVE.com

Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions

Here, we present a protocol to assess whether various types of silent cerebrovascular lesions are differentially associated with deficits in certain cognitive domains in a cohort of 398 hypertensive elderly Chinese, using a combination of neuropsychological tests and multi-sequence 3T MRI scanning.

Evidence accumulated from the last decade has proven that silent cerebrovascular lesions (SCLs) and their underlying pathogenic processes contribute to ...

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