The relevance of the problem of early diagnosis of cognitive impairment and
structural hemodynamic changes of the deep white matter of the brain (WM), which
play a leading role in their development at cerebral small vessels disease (CSVD),
determines the progressive growth in the population of dementia and cerebral stroke. The
lack of generally accepted clinical neuropsychological and neuroimaging criteria for
the initial stages of CSVD and the ambiguity of the correlation
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components of key links in its pathogenesis necessitate in-depth research using
modern medical technologies.
The purpose of the dissertation research was to increase the effectiveness of
early diagnosis of CSVD by determining the age characteristics of its clinical,
neuropsychological and neuroimaging features.
In the course of the work 110 patients of middle-age and elderly (main n = 34
and n = 37 and control n = 19 and n = 20) were investigated. Criteria for inclusion
in the main groups: age of patients 44-75 years; the diagnosis of arterial hypertension
(AH) was established for the first time (1-2 grades, I-II grades; duration of the
disease - up to 10 years); clinical signs of CDSW of the sporadic non-amyloid
microangiopathy (SNAMA) type, corresponding to stages I-II of dyscirculatory
encephalopathy without dominant neurological syndromes; subjective and moderate
cognitive impairment (MCI) detected at neuropsychological studies; initial signs of
atherosclerosis of brachiocephalic vessels according to ultrasound duplex scanning
(USDS); early visual MRI signs of CSVD in accordance with “The Standards for
Reporting Vascular Changes on Neuroimaging” (STRIVE).
To solve the problems related to the features of early diagnosis of SNAMA in
patients with type 2 diabetes mellitus (DM2) and in patients exposed to ionizing
radiation (IR), the corresponding main and control groups were additionally created:
AH + DM2: n = 22, AH: n = 25 and Contr.gr.: n = 15; AH + ІR: n = 20, AH: n = 25
and Contr.gr.: n = 15).
Investigations of patients were performed in the neurological departments of
the National Military Clinical Center "Main Clinical Hospital" of the Ministry of
Defense of Ukraine; SI "Scientific Center of Radiation Medicine of the National
Academy of Medical Sciences of Ukraine"; polyclinic-consultative department, US
and MRI departments of the SI “Institute of Nuclear Medicine and Diagnostic
Radiology of the National Academy of Medical Sciences of Ukraine”.
In the process of performing scientific work neuropsychological research with
scales МоСА (Montreal Cognitive Assessment), MMSE (Mini Mental State
Examination), tests of phonetic and semantic speech speed (SSR, PhSR), frontal
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assessment battery (FAB); multiparametric high-field (3T) MRI and diffusiontensor MRI (DTI-MRI) with definition of early visual signs of early structural
changes WM, early CSVD burden (BCSVDe), fractional anisotropy and diffusion
coefficients (FA and MD); USDS of the head/neck vessels with the calculation of
the volumetric velocity of cerebral blood flow (Tc VBF); general clinical and
laboratory investigations aimed at confirming the diagnosis of SNAMA and the
exclusion of other forms of CSVD.
For statistical analysis, the following was calculated: mean and standard
quadratic deviation (mean ± SD); median (Me) and interquartile interval (QI-QIII).
The Mann-Whitney test and the Spearman bivariate rank correlation coefficient (rs)
were used to compare the values.
The results of scientific research have led to conclusions that have certain
theoretical and practical value and are new compared to known modern scientific
developments.
For the first time, the features of early cognitive impairment, changes in the
structure and blood supply of WM at CSVD in terms of the age when it was clinically
manifested were studied. It was found that the initial clinical and neuropsychological
signs of CSVD, which first appear in 44-59 years, in nature and severity are almost
identical to age-related changes in 60-75-year-old healthy individuals: multidomain
non-amnestic MCI with preserved memory functions, time and spatial orientation,
semantic and phonetic speed of language. In the clinical manifestation of CSVD in
the elderly patients, the degree of decrease in scoring of cognitive functions relative
to the relevant control values is not so pronounced, but there is a significant
deterioration in memory (p<0,029), semantic (p<0,003) and phonetic (p<0,05) speed
of speech.
In patients with CSVD detected for the first time in the middle age, all MRI
and USDS indicators (Me: ∑BCSVDe – 4 vs. 2 points; FA in fibers: 0.405-0.474 vs.
0.485-0.592; FA outside the leading tracts: 0.212-0.362 vs. 0.284-0.456, MD: 0.212-
0.362x10-3mm2/s vs. 0.284-0.456x10-3mm2/s, p <0.001 and Tc VBF: 0.48 vs. 0.63
l/min, p <0.05) significantly different from the control quantities.
