The role of cholinergic pathway lesions in vascular cognitive impairment

Objective: To investigate the relationship between white matter lesions (WML) within the cholinergic pathway and vascular cognitive impairment. Method: Middle-aged and elderly stroke patients underwent brain MRI examination and Montreal Cognitive Assessment (MoCA). Cholinergic Pathways Hyperintensities Scale (CHIPS) scores and the overall WML burden by Schelten on fluid-attenuated inversion recovery MRI images were determined and compared with MoCA scores. Spearman partial rank correlation coefficients and standardized regression coefficients were calculated. Results: Thirty four patients were included (mean age (62.2 ± 8.8) years, 45-82 years). MoCA scores negatively correlated with WML burdens by Schelten scores (β=-0.357, P=0.042) and CHIPS scores (β=-0.382, P=0.026). CHIPS scores were negatively associated with visuospatial and executive function (r=-0.290, P=0.048), naming function (r=-0.486, P=0.002), attention (r=-0.311, P=0.037) and abstraction (r=-0.344, P=0.023). Schelten scores were negatively associated with naming function (r=-0.492, P=0.002), attention (r=-0.364, P=0.017) and abstraction (r=-0.390, P=0.011). Conclusion: WML lesions within the cholinergic pathyway play a possible role in vascular cognitive impairment especially in visuospatial and executive function.