Early markers and predictors of cerebrovascular diseases in a group of young and middle-aged employees of the EMERCOM of Russia

Abstract

Introduction. Typical basis of chronic cerebral ischemia in young people is small vessel disease (SVD) diagnosed by micro-focal lesions and microstructural damage of cerebral white matter (WM), reduction of fractional anisotropy (FA) in diffusion tensor MRI (DT-MRI). Previous studies showed that increased dopplerographic pulsatility and resistivity indices in middle cerebral artery (MCA PI-RI) correlated with SVD manifestations and cognitive impairment in middle-aged and elderly patients. Aim – to determine early markers and predictors of asymptomatic SVD in young and middle-aged individuals without cognitive impairment. Materials and methods. 52 male employees of the EMERCOM, 47.3±7.6 years, without neurological or cognitive deficits were examined. Duplex scanning with MCA PI-RI calculation, MRI with WM damage assessment according to Fazekas scale, DT-MRI FA definition were completed. Results. All those examed showed MRI signs of SVD. Two groups were formed according to Fazekas: 0 points (n-38) and 1-2 points (n-14). The 2nd group showed higher MCA PI-RI (p<0.002 and p<0.05). Multivariate logistical regression analysis showed significant correlation of PI in MCA (OR: 2.33; 95% CI: 1.13- 4.81; p=0.02) with WM lesion according to Fazekas. The FA in cognitively important tracts was lower in group 2 (p<0,001). A stepwise multiple linear regression model revealed that the strongest predictors of FA reduction were PI and RI. The values of psychomotor speed and attention span were lower in group 2. Conclusion. MCA PI-RI are early markers of focal lesions and microstructural changes in WM and predictors of cognitive impairment in the young and middle-aged with asymptomatic SVD.