Nomogram to Predict Cognitive Impairment in Patients with Asymptomatic Middle Cerebral Artery Stenosis

Figures & data

Table 1 Characteristics of All Patients in the CN and CI Groups

	CN (n=24)	CI (n=30)	Z/t	P
Baseline characteristics
Sex (Male)	16	17	0.561^c	0.454
Age	51.5±10.70	55±11.26	−0.796^a	0.430
Education (>9 years)	13	18	0.186^c	0.667
Hypertension	14	14	0.727^c	0.394
Diabetes	8	6	1.234^c	0.267
Smoking history	11	15	0.093^c	0.761
Drinking history	8	7	0.665^c	0.415
Degree of stenosis			2.684^c	0.101
Moderate to severe	18	16
Occlusion	6	14
Side of the stenosis (Left)	12	9	2.244^c	0.134
Perfusion period			9.966^c	0.007*
Normal	6	3
Compensation	15	11
Decompensation	3	16
Fazekas grade			3.477^c	0.324
Fazekas grade 0	6	3
Fazekas grade 1	7	7
Fazekas grade 2	7	10
Fazekas grade 3	4	10
Collateral compensation				0.905^d
None	6	8
AcoA	4	7
PcoA	5	5
AcoA+PcoA	6	4
Pial collateral	2	4
Neovascularization	1	1
TCD parameters
MCA MFV	109(53.25, 189.5)	58.3(41.9, 90.75)	−2.995^b	0.003*
MCA PI	0.70(0.52, 1.13)	0.80(0.65, 1.11)	−1.306^b	0.192
Blood tests
PT	12.05(11.25, 12.4)	11.85(11.40, 13.58)	−0.479^b	0.632
APTT	28.85±3.96	26.59±5.80	1.628^a	0.11
TT	18.1(17.65, 18.5)	17.75(17.3, 19.4)	−0.322^b	0.747
AT-III	87.07±23.76	93.82±15.18	−1.268^a	0.21
FDP	2.5(0.54, 2.5)	1.47(0.93, 2.5)	−0.354^b	0.724
D-D	0.25(0.17, 36.69)	0.57(0.14, 32.08)	−0.331^b	0.741
FT3	4.76±0.83	4.79±0.60	−0.187^a	0.85
FT4	16.60±2.63	16.62±3.43	−0.029^a	0.98
TSH	2.25±1.33	2.00±1.07	0.762^a	0.45
TC	3.55±0.91	4.18±1.13	−2.174^a	0.03 *
TG	1.34(0.84, 1.54)	1.49(1.15, 2.47)	−1.889^b	0.059
HDL-c	0.88(0.80, 1.06)	1.06(0.85, 1.11)	−1.376^b	0.169
LDL-c	2.24±0.75	2.80±0.76	−2.717^a	0.01 *
CRE	64.65±8.62	66.09±17.82	−0.39^a	0.70
UA	332.9(245.03, 372.95)	304.2(251.76, 432.15)	−0.548^b	0.583
Urea	4.3(3.96, 5.60)	5.05(4.16, 6.17)	−1.122^b	0.262
HCY	13.6(11.93, 21.2)	14.2(10, 17.95)	−0.583^b	0.560
FA	17.50±7.24	23.66±15.11	−1.969^a	0.060
B12	113.5(88, 166)	146(109, 279)	−1.550^b	0.121

Notes: *P<0.05; ^aThe t value of the two-sample independent t-test; ^bThe Z value of t Mann–Whitney U-test; ^cThe P value of chi-square test exact test; ^dThe P value of Fisher exact test.

Abbreviations: AcoA, anterior communicating artery; PcoA, posterior communicating artery; MFV, mean flow velocity; PI, pulsatility index; PT, prothrombin time; APTT, activated partial thromboplastin time; TT, thrombin time; AT-III, antithrombin III; FDP, fibrin degradation products; D-D, D-dimer; TSH, thyroid stimulating hormone; FT3, free triiodothyronine; FT4, free thyroxine; TC, total cholesterol; TG, triglyceride.; HDL-c, HDL cholesterol; LDL-c, LDL cholesterol; CRE, Creatinine; UA, uric acid; HCY, homocysteine; FA, folic acid; B12, vitamin B12.

Table 2 Comparison of Cognitive Function in Patients with aMCAS Under Different Perfusion Periods

	Healthy Control	Normal	Compensation	Decompensation	F/H	P
Number	35	9	26	19
MoCA	26.31±1.87	25.22±2.39	24.07±4.05	19.31±4.41*^#'	17.034	0.001
Short-delay recall	9.03±1.42	8.56±2.07	8.27±1.89	7.74±1.63	2.625	0.056
Long-delay recall	7.46±1.46	7.00±2.06	6.50±1.70	5.21±1.23*^#'	8.769	0.001
Cued recall	10(10, 11)	10(9, 11)	10(8.75, 11)*	9(8, 10)*	19.623	0.001
Recognition	11(11, 12)	11(10.5, 12)	11(10, 11)	10(10, 11)	7.541	0.057
VFT	17.29±1.79	16.56±1.42	16.54±1.61	16.47±1.50	1.543	0.209
mBNT	15(14, 15)	15(14.5, 15)	15(14, 15)	14(14, 15)	6.969	0.073
DSF	8(7, 9)	8(7, 8)	8(7, 9)	8(7, 9)	1.507	0.681
DSB	5(4, 6)	4(4, 6)	4(4, 5)*	4(3, 4)*	21.474	0.001
SDMT	42(38, 43)	41.5(39.5, 43.5)	40(37.88, 41.25)*^#	39(38, 40)*^#	9.894	0.019
RCFT	35(35, 36)	35(35, 36)	35(34, 36)	35(34, 36)	2.827	0.419
TMT-A	29.43±3.85	31±5.68	32.08±4.37	33.47±7.40*	2.908	0.039
TMT-B	57(52, 63)	59(55, 63.5)	70(64.75, 75.25)*^#	71(67, 95)*^#	42.383	0.001
SCWT-A	43.94±7.99	43.01±8.12	48.81±8.86	48.71±8.98	2.624	0.056
SCWT-B	56.61±6.97	57.81±6.79	64.50±8.00*	66.35±7.74*^#	9.804	0.001
SCWT-C	97.16±7.84	97.76±5.37	121.08±15.86*^#	123.92±12.02*^#	35.349	0.001
SIE	40.9(34.02, 45.77)	41.33(36.55, 42.91)	58.73(45.37, 65.25)*^#	63.92(43.47, 67.23)*^#	39.637	0.001

Notes: *Compared with healthy control, P<0.05; ^#Compared with CTP normal group, P<0.05; 'Compared with CTP compensation group, P<0.05.

Abbreviations: MoCA, Montreal cognitive assessment scale; VFT, verbal fluency test; mBNT, the modified Boston naming test; DSF, digit span forward; DSB, digit span backward; SDMT, Symbol-digit Modalities Test; RCFT, Rey-Osterrieth complex figure test; TMT, trail making test; SCWT, Stroop color-word task; SIE, stroop interference ensues.

Table 3 Univariate and Multifactor Logistic Regression Results of Cognitive Impairment in Patients with aMCAS

Variables	Univariate Regression		Multivarate Regression
	OR (95% CI)	P	OR (95% CI)	P
Baseline characteristics
Sex	1.275(0.425, 3.819)	0.665
Age	1.021(0.971, 1.073)	0.422
Education	1.224(0.373, 4.017)	0.739
Hypertension	0.653(0.202, 2.114)	0.477
Diabetes	0.428(0.097, 1.895)	0.264
Smoking history	2.145(0.558, 8.255)	0.267
Drinking history	0.760(0.197, 2.938)	0.691
Degree of stenosis
Moderate to severe	0.381(0.118, 1.227)	0.106
Occlusion	NA	NA
Side of the stenosis	0.429(0.14, 1.311)	0.137
Perfusion period		0.014
Normal	NA	NA
Compensation	1.467(0.299, 7.188)	0.637	1.545(0.233, 10.258)	0.653
Decompensation	10.667(1.669, 68.183)	0.012	15.220(1.461, 158.606)	0.023*
Fazekas grade		0.348
Fazekas grade 0	NA	NA
Fazekas grade 1	2 (0.352, 11.364)	0.434
Fazekas grade 2	2.528(0.528, 15.473)	0.223
Fazekas grade 3	5(0.821, 30.461)	0.081
Collateral compensation		0.792
None	NA	NA
AcoA	1.867(0.444, 7.852)	0.394
PcoA	1.778(0.316, 10.013)	0.514
AcoA and PcoA	5.333(0.506, 56.236)	0.164
Pial collateral	6.667(0.659, 67.463)	0.108
Neovascularization	0.667(0.052, 8.549)	0.755
TCD parameters
MCA MFV	0.354(0.174, 0.722)	0.004	0.412(0.191, 0.893)	0.025*
MCA PI	1.446(0.75, 2.785)	0.271
Blood tests
PT	1.522(0.826, 2.805)	0.178
APTT	0.625(0.349, 1.12)	0.114
TT	1.336(0.69, 2.588)	0.391
AT-III	1.452(0.799, 2.638)	0.221
FDP	0.826(0.454, 1.503)	0.531
D-D	0.815(0.468, 1.42)	0.471
FT3	1.054(0.613, 1.812)	0.849
FT4	1.008(0.586, 1.733)	0.977
TSH	0.807(0.466, 1.397)	0.443
TC	1.879(1.03, 3.43)	0.040
TG	2.215(1.121, 4.378)	0.022
HDL-c	1.2(0.693, 2.078)	0.515
LDL-c	2.239(1.178, 4.257)	0.014	2.409(1.110, 5.228)	0.026*
CRE	1.108(0.642, 1.912)	0.712
UA	1.296(0.736, 2.283)	0.368
Urea	1.248(0.709, 2.195)	0.443
HCY	0.819(0.467, 1.436)	0.486
FA	1.748(0.933, 3.275)	0.081
B12	1.591(0.793, 3.193)	0.191

Notes: *P<0.05. Variables with P<0.1 in univariate regression were subject to multivariate stepwise backward logistic regression.

Abbreviations: AcoA, anterior communicating artery; PcoA, posterior communicating artery; MFV, mean flow velocity; PI, pulsatility index; PT, prothrombin time; APTT, activated partial thromboplastin time; TT, thrombin time; AT-III, antithrombin III; FDP, fibrin degradation products; D-D, D-dimer; TSH, thyroid stimulating hormone; FT3, free triiodothyronine; FT4, free thyroxine; TC, total cholesterol; TG, triglyceride.; HDL-C, HDL cholesterol; LDL-C, LDL cholesterol; CRE, Creatinine; UA, uric acid; HCY, homocysteine; FA, folic acid; B12, vitamin B12.

Figure 1 Nomogram for predicting cognitive impairment in patients with aMCAS.

Figure 2 ROC curves (A), calibration curves (B), DCA curve (C) and CIC (D) of the nomogram.