Türk Beyin Damar Hast Derg. 2021; 27(2): 133-138 | DOI: 10.5505/tbdhd.2021.59389

The effect on cognitive functions of vascular lesion localizations and vascular load in the brain

Ýlker Öztürk¹, Aygül Tantik Pak², Hakan Serdar Þengül³, Sebahat Nacar Doðan⁴, Yýldýzhan Þengül^2
1Adana City Training and Research Hospital, Depertmant of Neurology, Adana, Turkey
²Gaziosmanpasa Training and Research Hospital, Depertmant of Neurology, Ýstanbul, Turkey
³Gaziosmanpasa Training and Research Hospital, Depertmant of Psychiatry, Ýstanbul, Turkey
⁴Gaziosmanpasa Training and Research Hospital, Depertmant of Radiology, Ýstanbul, Turkey

INTRODUCTION: The presence of vascular lesions may be a risk factor for neurodegenerative diseases. The white matter lesions, small vessel disease, and lacunar infarcts are known to be associated with cognitive functions impairment.However, the location of these vascular lesions, and the effect of vascular load on cognition have not been clarified yet.In this study, it was aimed to investigate the effects of the localization areas of vascular lesions and vascular load on impairment of cognitive functions.
METHODS: Fifty-two patients who underwent Mini Mental State Examination (MMSE) were included in the study. Exclusion criteria were ischemic stroke other than small vessel disease, alcohol abuse, and traumatic brain disease. The MMSE were divided into subitems (orientation, recording memory, attention and calculation, recall, and language). The magnetic resonance imagings (MRI) of the patients were analyzed. The locations areas of the vascular lesions (juxtacortical, periventricular and deep brain structures), and the presence of subcortical atrophy were recorded. Fazekas scale was used for the severity of vascular lesion load.
RESULTS: The mean age of the patients was 75.01±10.23 (range 53-84) years; 61.5% of the patients were female. MMSE was normal in 14 (26.9%) of the patients. The factors affecting the orientation in the multiple regression analysis were as follows: subcortical atrophy (p= 0.036, β= -0.323), and periventricular vascular lesions (p= 0.024, β= -0.449). The recall was found to be affected by subcortical atrophy (p= 0.048, β= -0.295). Additionally, it was analyzed that subcortical atrophy (p= 0.024, β= -0.345), juxtacortical area (p= 0.028, β= -0.423), and vascular lesions located in deep brain structures (p= 0.031, β= -0.395) affected the recording memory. The only factor affecting the MMSE was the subcortical atrophy (p= 0.034, β= -0.341). Subcortical atrophy was found to be the only effective factor in detecting dementia (p= 0.034, β= 0.291).
DISCUSSION AND CONCLUSION: It was found that subcortical atrophy detected in MRI was the most effective factor in the development and progression of dementia, and that vascular load had no effect on dementia.

Keywords: White matter lesions, dementia, cognition, small vessel disease, lacunar infarct, Mini Mental State Examination, vascular lesions

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Beyinde vasküler lezyon yerleþim alanlarýnýn ve vasküler yükün kognitif fonksiyonlara etkisi

Ýlker Öztürk¹, Aygül Tantik Pak², Hakan Serdar Þengül³, Sebahat Nacar Doðan⁴, Yýldýzhan Þengül^2
1Adana Þehir Eðitim ve Araþtýrma Hastanesi, Nöroloji Kliniði, Adana
²Gaziosmanpaþa Eðitim ve Araþtýrma Hastanesi, Nöroloji Kliniði, Ýstanbul
³Gaziosmanpaþa Eðitim ve Araþtýrma Hastanesi, Psikiyatri Kliniði, Ýstanbul
⁴Gaziosmanpaþa Eðitim ve Araþtýrma Hastanesi, Radyoloji Kliniði, Ýstanbul

GÝRÝÞ ve AMAÇ: Vasküler lezyonlarýn varlýðý nörodejeneratif hastalýklar için risk faktörü oluþturabilir. Kognitif iþlevlerin bozulmasýnda beyaz cevher lezyonlarý, küçük damar hastalýðý ve laküner enfarktlarýn rolü bilinmektedir. Ancak bu vasküler lezyonlarýn yerleþim yerleri ve vasküler yükün kognisyon üzerine etkisi tam olarak açýklýk kazanmamýþtýr. Bu çalýþmada amacýmýz vasküler lezyonlarýn yerleþim alanlarýnýn ve vasküler yükün kognitif fonksiyonlarýn bozulmasý üzerine etkisini araþtýrmaktý.
YÖNTEM ve GEREÇLER: Çalýþmaya mini mental test (MMT) uygulanan 52 hasta dahil edildi. Dýþlama kriterleri, küçük damar hastalýðý dýþýnda iskemik inme geçirmek, alkol ve madde kullanýmý olmak, travmatik beyin hastalýðýydý. MMT alt gruplara (Yönelim, kayýt hafýzasý, dikkat ve hesaplama, hatýrlama ve lisan) ayrýldý. Hastalarýn MRG’leri incelendi, vasküler leyonlarýn yerleþim yerleri (juxtakortikal, periventriküler ve derin beyin yapýlarý) ve subkortikal atrofileri kaydedildi. Vasküler lezyon þiddetini belirlemek için Fazekas kullanýldý.
BULGULAR: Hastalarýn %61,5’i kadýn olup, yaþ ortalamasý 75,01±10,23 (yaþ aralýðý: 53-84) idi. Hastalarýn %26,9’unda (n=14) MMT normaldi. Çoklu regresyon analizinde yönelime etkisi olan faktörler; subkortikal atrofi (p= 0,036, β= -0,323) ve periventriküler yerleþimli vasküler lezyonlardý (p= 0,024, β= -0,449). Hatýrlamayý etkileyen faktörler; subkortikal atrofi (p= 0.048, β= -0.295) olarak saptanmýþtýr. Kayýt hafýzasýný etkileyen faktörler ise subkortikal atrofi (p= 0,024, β= -0,345), jukstakortikal alanda (p= 0,028, β= -0,423) ve derin beyin yapýlanlarýnda yerleþen vasküler lezyonlar (p= 0,031, β= -0,395) olarak saptanmýþtýr. Toplam MMT etki eden tek faktör subkortikal atrofi olarak belirlenmiþtir (p= 0,034, β= -0,341). Demansýn saptanmasýnda ise tek etkili faktörün subkortikal atrofi olduðu saptanmýþtýr (p= 0,034, β= 0,291).
TARTIÞMA ve SONUÇ: Demansýn geliþiminde ve ilerlemesinde MRG’de saptanan subkortikal atrofinin en etkili faktör olduðu gözlenmiþ olup Fazekas evrelerinin yani vasküler yükün etkisinin olmadýðý saptanmýþtýr.

Anahtar Kelimeler: Beyaz cevher lezyonlarý, demans, kognisyon, küçük damar hastalýðý, laküner enfarkt, Mini Mental Test, vasküler lezyonlar.

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