Research Paper Volume 11, Issue 2 pp 634—648

Efficacy of remote ischemic conditioning on improving WMHs and cognition in very elderly patients with intracranial atherosclerotic stenosis

Da Zhou 1, 4, 5, *, , Jiayue Ding 1, 4, 5, *, , Jingyuan Ya 1, 4, 5, , Liqun Pan 1, 4, 5, , Chaobo Bai 1, 4, 5, , Jingwei Guan 1, 4, 5, , Zhongao Wang 1, 4, 5, , Kexin Jin 1, 4, 5, , Qi Yang 3, 5, , Xunming Ji 2, 4, 5, , Ran Meng 1, 4, 5, ,

  • 1 Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
  • 2 Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
  • 3 Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
  • 4 Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
  • 5 Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
* Equal contribution

received: October 7, 2018 ; accepted: January 5, 2019 ; published: January 28, 2019 ;

https://doi.org/10.18632/aging.101764
How to Cite

Copyright: Zhou et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Our previous study revealed that remote ischemic conditioning (RIC) reduced the incidence of stroke or TIA in octo- and nonagenarians with intracranial atherosclerotic stenosis (ICAS). Herein, we aimed to investigate whether RIC would influence the progression of white matter hyperintensities (WMHs) and cognitive impairment in the same group of patients. Fifty-eight patients with ICAS were randomly assigned in a 1:1 ratio to receive standard medical treatment with RIC (n=30) versus sham-RIC (n=28). The RIC protocol consisted of 5 cycles of alternating 5-min ischemia and 5-min reperfusion applied in the bilateral upper arms twice daily for 300 days. The efficacy outcomes included WMHs change on T2 FLAIR sequences, estimated by the Fazekas scale and Scheltens scale, cognitive change as assessed by the MMSE and MoCA, and some clinical symptoms within 300-day follow-up. Compared with the baseline, RIC treatment significantly reduced Fazekas and Scheltens scores at both 180-day (both p<0.05) and 300-day (both p<0.01) follow-ups, whereas no such reduction was observed in the control group. In the RIC group, Fazekas scores were significantly lower at 300-day follow-up (p<0.001) while Scheltens scores were significantly lower at both 180-day and 300-day follow-ups (both p<0.001), as compared with the control group. There were statistically significant between-group differences in the overall MMSE or MoCA scores, favoring RIC at 180-day and 300-day follow-ups (all p<0.05). RIC may serve as a promising adjunctive to standard medical therapy for preventing the progression of WMHs and ameliorating cognitive impairment in very elderly patients with ICAS.

Abbreviations

WMHs: White matter hyperintensities; WM: white matter; CBF: cerebral blood flow; ICAS: intracranial atherosclerotic stenosis; CCI: chronic cerebral ischemia; RIC: remote ischemic conditioning; CSVD: cerebral small-vessel disease; MRA: magnetic resonance angiography; CTA: computed tomography angiography; NIHSS: National Institutes of Health Stroke Scale; mRS: modified Rankin Scale; T2 FLAIR: T2 fluid-attenuated inversion recovery; MMSE: Mini-Mental State Examination; MoCA-BJ: Beijing version of the Montreal Cognitive Assessment; MCD: mild cognitive decline..