Essen stroke risk score, cerebral cholinergic pathways and cognitive performances in patients with cerebral small vessel disease

Background: Essen stroke risk score (ESRS) has been proposed for predicting recurrent risk of stroke caused by extraand intra-cranial atherosclerotic disease. Nevertheless, the role of ESRS in cognition associated with cerebral small vessel disease (CSVD) has not been reported to our knowledge. We investigated the relationship between higher ESRS and impaired cognitive performances in patients with CSVD, with the hypothesis that cerebral cholinergic deafferentation may be one of the mechanisms. Methods: ESRS and Montreal cognitive assessment (MoCA) were assessed in 102 consecutive patients (mean age (67.2 ± 8.3) years, 48-85 years) with magnetic resonance imaging (MRI) finding of CSVD admitted to our department from 2009 to 2012. The severity of brain cholinergic tracts lesions was measured by the cholinergic pathways hyperintensities scale (CHIPS) score on fluid attenuated inversion recovery (FLAIR) MRI image. Descriptive analysis, pearson correlation as well as stepwise multiple regression analysis was performed. Results: Of the 102 patients included, for each point increase in ESRS and CHIPS scores, the probability of lower MoCA score increased by 0.696 (p=0.075) and 0.071 (p=0.007) respectively after controlling educational level as a covariate. In the full model, educational level explained 13% of MoCA variance, while ESRS and CHIPS explained an additional 12%. What is more, higher ESRS resulted in lower MoCA score partially via increase in CHIPS score (0.290 point in MoCA for each point in CHIPS). Conclusions: Cognitive performance negatively correlated with ESRS in patients with CSVD probably via cerebral cholinergic pathways to some extent. ESRS has potential to be a simple tool for CSVD indicating impaired cerebral cholinergic system Correspondence to: Qiang DONG, MD, PhD, No.12 Middle Urumqi Road, Shanghai, China, 200040, Tel: 021-52887145, E-mail: [email protected] Xiang HAN, MD, PhD, No.12 Middle Urumqi Road, Shanghai, China, 200040, E-mail: [email protected]