Objective To investigate the risk factors for abnormal cardiac function in patients with hepatolenticular degeneration （also known as Wilson disease ，WD） using cardiac magnetic resonance imaging （CMR）， and to identify indicators with a value for early diagnosis. Methods Patients diagnosed with WD were randomly selected to undergo CMR examination， and based on CMR findings， they were divided into abnormal group and normal group. A univariate analysis was used to obtain potential risk factors， then a multivariate logistic regression analysis was performed for variables with a significant difference， and finally the receiver operating characteristic （ROC） curve analysis was performed for the independent risk factors identified. Results A total of 42 WD patients were enrolled， with 21 in the abnormal CMR group and 21 in the normal CMR group. Compared with the normal CMR group， the abnormal CMR group had a significantly higher age and significantly higher levels of total bilirubin， serum copper， and peak 24-hour urinary copper during treatment. The multivariate Logistic regression analysis showed that white blood cell count （WBC） （OR=2.927， 95%CI 1.127‒7.839， P=0.028）， serum copper（OR=3.822， 95%CI 1.108‒13.178， P=0.034）， and type Ⅳ collagen （OR=1.097， 95%CI 1.011‒1.191，P=0.027） were independent risk factors for CMR abnormalities in WD patients. The ROC curve analysis showed that among the above three indicators used alone， serum copper had the highest diagnostic value with an area under the ROC curve （AUC） of 0.713， followed by WBC（AUC=0.651） and type Ⅳ collagen （AUC=0.644）， and the combination of these three indicators had significantly higher diagnostic efficacy （AUC=0.869）. Conclusion Serum copper is the single indicator with the highest diagnostic efficacy for CMR abnormalities in WD patients， but the combination of serum copper， WBC， and type Ⅳ collagen has a significantly better diagnostic value in identifying abnormal cardiac function in WD patients.

Objective To quantitatively analyze the volumetric characteristics of each subregion of the basal ganglia in patients with hepatolenticular degeneration （also known as Wilson disease ，WD） using brain magnetic resonance imaging （MRI） and brain segmentation technology， to explore the specific imaging findings of choreiform symptoms， and to assess the clinical value of caudate nucleus atrophy as an imaging indicator for this symptom. Methods A retrospective analysis was performed for 40 WD patients with choreiform symptoms and 40 patients without choreiform symptoms from June 2023 to June 2025， and clinical indicators were compared between the two groups. In addition， the two groups were compared in terms of the volume of the basal ganglia after estimated total intracranial volume （eTIV） correction， and the correlation between the volume of differential brain regions and the chorea subscale score of Unified Wilson's Disease Rating Scale （UWDRS） was explored. Results There were no significant differences in baseline data between the two groups. UWDRS scores showed that the choreiform group had a higher neurological function score （P=0.005）， a significantly higher chorea subscale score （P<0.01）， and a lower hepatic function score （P<0.01）. The choreiform group had a significantly smaller caudate nucleus volume than the non-choreiform group （P<0.001）， suggesting severe subregional atrophy， and in contrast， the choreiform group had a significant increase in thalamus volume （P=0.002）. Caudate nucleus volume ratio was significantly negatively correlated with chorea subscale score in the choreiform group （P<0.001）. Conclusion Caudate nucleus atrophy is a specific imaging finding of choreiform symptoms in WD patients， and a quantitative analysis of caudate nucleus volume is expected to become an objective imaging indicator for assessing the severity of choreiform symptoms and monitoring disease progression in WD.

Objective To investigate the cranial magnetic resonance imaging （MRI） features of patients with hepatolenticular degeneration （also known as Wilson disease，WD） and epilepsy， and to identify the neuroimaging risk factors for seizures in WD patients. Methods A total of 69 WD patients with epilepsy who were hospitalized in Affiliated Hospital of Neurology Institute， Anhui University of Chinese Medicine， from January 2018 to November 2025 were enrolled as study group， while 80 WD patients without seizures， matched for sex and age， during the same period of time were randomly selected as control group. Cranial MRI findings were compared between the two groups. Results There were 69 WD patients （43 male patients and 26 female patients） in the study group， with a mean age of （29.46±8.58） years at the time of attending the hospital， and all these patients had abnormal electroencephalogram （EEG） findings. There were no significant differences between the two groups in age of onset，disease duration， WD subtype， and serum copper. Cranial MRI showed that the putamen was the most common site of brain injury （47 patients， 68.1%）， followed by the frontal lobe （40 patients，58.0%） and the parietal lobe （31 patients，44.9%）， and there was a significantly higher probability of epilepsy in patients with abnormal lesions in the frontal， temporal， or parietal lobes （P<0.05）. Conclusion While the putamen is the most common site of brain injury in WD patients with epilepsy， frontal or temporal lobe injuries are neuroimaging risk factors for seizures in such patients.

Objective To compare the clinical and cranial magnetic resonance imaging （MRI） features of neurological hepatolenticular degeneration （also known as Wilson disease，WD） with two different ATP7B gene mutations， and to investigate the association between the clinical and cranial MRI features in patients with the two mutation types of neurological WD. Methods The neurological WD patients with p.Arg778Leu or p.Pro992Leu homozygous mutation who were hospitalized in Affiliated Hospital of Neurology Institute， Anhui University of Chinese Medicine， from May 2014 to May 2025 were enrolled， and a retrospective analysis was performed for their demographic data， clinical manifestations， serological markers， and cranial MRI data to compare the differences between the two mutation types of neurological WD. Results A total of 103 neurological WD patients were enrolled， among whom there were 65 patients with p.Arg778Leu-mutant WD and 38 patients with p.Pro992Leu-mutant WD. There were no significant differences in demographics， clinical manifestations， and most serological markers between the two mutation types of WD， while there was a significant difference in cranial MRI findings between two groups， with significant differences in the damage of the thalamus （χ²=17.834，P<0.001），the midbrain （χ²=12.579， P<0.001）， and the pons （χ²=10.605， P=0.001） between the patients with p.Arg778Leu-mutant WD and those with p.Pro992Leu-mutant WD， and the multivariate analysis also showed significant differences in the above indicators （P<0.05）. Conclusion Demographic data， clinical manifestations， and serological markers are not associated with gene mutation types in neurological WD， while cranial MRI manifestations are associated with gene mutation types， among which p.Arg778Leu mutation of the ATP7B gene is more likely to involve the thalamus， the midbrain， and the pons.

Objective To investigate the value of plasma glial fibrillary acidic protein （GFAP） and homocysteine （Hcy） in the diagnosis of hepatolenticular degeneration （also know as Wilson disease， WD） and the differential diagnosis of the hepatic and neurological forms of WD. Methods A total of 120 WD patients who were admitted to Encephalopathy Center of our hospital from January 2023 to January 2025 were enrolled， among whom there were 63 patients with neurological WD and 57 patients with hepatic WD， and 30 healthy volunteers who underwent physical examination during the same period of time were enrolled as control group. ELISA was used to measure the plasma levels of GFAP and Hcy， and the differences between groups were analyzed. The receiver operating characteristic（ROC） curve analysis was performed， and the Spearman correlation analysis was used to investigate the correlation of the plasma levels of GFAP and Hcy with Unified Wilson Disease Rating Scale （UWDRS） score， 24-hour urinary copper， and the serum level of ceruloplasmin （CER）. Results The patients with hepatic or neurological WD had a significantly higher plasma level of GFAP than the control group（P<0.05）， and the patients with neurological WD had a significantly greater increase than those with hepatic WD（P<0.05）. The patients with hepatic or neurological WD also had a significant increase in the plasma level of Hcy（P<0.05）， but with no significant difference between the patients with hepatic WD and those with neurological WD.Plasma GFAP had an area under the ROC curve（AUC） of 0.861 in the diagnosis of neurological WD， with a cut-off value of 135.71 pg/ml， a sensitivity of 68.3%，and a specificity of 82.3%；plasma GFAP had an AUC of 0.695 in the diagnosis of hepatic WD， with a cut-off value of 129.84 pg/ml， a sensitivity of 64.7%， and a specificity of 83.3%； in the differential diagnosis of hepatic and neurological WD， plasma GFAP had an AUC of 0.75， with a cut-off value of 151.12 pg/ml，a sensitivity of 73.9%， and a specificity of 87.8%. Plasma Hcy had an AUC of 0.788 in the diagnosis of WD， with a cut-off value of 15.59 μmol/L， sensitivity of 77.9%， and specificity of 66.7%. The Spearman correlation analysis showed that in the patients with hepatic or neurological WD， the plasma levels of GFAP and Hcy were positively correlated with UWDRS score and 24-hour urinary copper （P<0.05）， but they were not significantly correlated with the level of CER （P>0.05）. Conclusion The plasma levels of GFAP and Hcy are closely associated with the degree of neurological and hepatic impairment in WD， which provides a certain clinical value for the early diagnosis of WD and the differential diagnosis of hepatic and neurological WD.

Objective Hepatolenticular degeneration（also know as Wilson disease ，WD） is a copper metabolic disorder caused by ATP7B gene mutation， often involving the liver and the central nervous system and leading to death in severe cases. At present， there is a lack of systematic studies on the cause of death and related risk factors in WD patients. Therefore， this study aims to investigate the common causes of death and related risk factors in WD patients. Methods A retrospective analysis was performed for the clinical data of 87 WD patients who died and 113 WD patients who survived in our hospital from January 2011 to January 2022. The common causes of death in WD patients were analyzed， and the Cox proportional-hazards regression model analysis was used to investigate the risk factors for death. Results The death group had a median age of 32.00 （27.00，41.00） years and a median course of disease of 144.00 （72.00，228.00） months， and the survival group had a median age of 31.00 （25.00，37.00） years and a median course of disease of 132.00 （72.00，214.00） months. The main causes of death included liver failure （33 patients）， infection （23 patients）， sudden death （8 patients）， gastrointestinal bleeding （8 patients）， and liver cancer （4 patients）. There were significant differences between the death group and the survival group in sex， pattern of disease onset， low copper diet， liver ultrasound classification， splenectomy， clinical classification， treatment regimens， and various laboratory markers （such as white blood cell count， total bilirubin， and albumin）（P<0.05）. The multivariate Cox regression analysis showed that the risk of death was doubled for every 100 μg/24 h increase in urinary copper at baseline （HR=1.22，95%CI 1.11-1.34） and the presence of liver cirrhosis （HR=2.55，95%CI 1.02-6.36）. Conclusion Liver failure is the main cause of death in WD patients， and a high level of urinary copper at baseline and the presence of liver cirrhosis significantly increase the risk of death. The risk of death in patients with a urinary copper level of 400 μg/24 h （reference value<100 μg/24 h） was increased by 3.8 times compared with the value at baseline （HR=3.8，P<0.001）.The results of this study provide an important basis for the prognosis evaluation and clinical intervention of WD patients.

Objective To investigate the changing trend of sleep disturbance in patients with hepatolenticular degeneration and the bidirectional relationship between sleep disturbance and depression through a cross-lagged regression analysis. Methods A total of 80 patients who met the diagnostic criteria for WD from January to June 2024 were enrolled in this longitudinal study and were followed up for 3 months.Pittsburgh Sleep Quality Index （PSQI） was used to assess sleep quality， and Beck Depression Inventory （BDI） was used to assess the severity of depression， at the time of enrollment （T0）， at 1 month after enrollment （T1），and at 2 months after enrollment （T3）. An unconditional growth model was used to analyze the trajectory of sleep disturbance， and a cross-lagged regression model was used to investigate the temporal relationship between sleep disturbance and depression. Results From T0 to T2， there were significant increases in PSQI and BDI scores in all WD patients（P<0.05）. The variance of the intercept factor （the initial status of sleep disturbance） was estimated at 10.83（P<0.01），and the variance of the slope factor （the rate of change in sleep disturbance） was 1.20 （P<0.01），with a significant negative correlation between the intercept and the slope （r=-0.25，P<0.01）. The correlation analysis of PSQI and BDI scores across the three time points revealed a positive correlation between PSQI and BDI scores （r∈[0.19，0.96]，P<0.01）.The cross-lagged model analysis showed that sleep disturbance significantly predicted subsequent depression （P<0.01），with standardized regression coefficients （β） of 0.392 and 0.347， respectively； meanwhile， depression also significantly predicted subsequent sleep disturbance （P<0.01）， with β of 0.273 and 0.372， respectively. These findings suggested a bidirectional predictive relationship between sleep disturbance and depression in WD patients over time. Conclusion There is a bidirectional relationship between sleep disturbance and depression in patients with WD， and depression has a more pronounced influence on sleep disturbance. Therefore， clinical interventions should focus on both sleep and psychological state， and combined management should be performed to improve the effect of disease control.

Hepatolenticular degeneration （HLD） is an autosomal recessive genetic disorder characterized by copper metabolism impairment， and it is one of the few treatable neurogenetic diseases. A retrospective analysis was performed for the clinical data of four patients with HLD who attended Beijing Ditan Hospital， Capital Medical University， from November 2023 to October 2024， and the genetic testing results of three patients were analyzed， along with a literature review. Among the four patients， there was one female patient and three male patients. All patients had the initial symptoms of dysarthria and limb tremors， and physical examination showed positive K-F rings， normal liver enzyme levels， a reduction in serum ceruloplasmin， and an increase in 24-hour urinary copper excretion. Three patients underwent ATP7B genetic testing， among whom two had compound heterozygous mutations， and one had a heterozygous mutation. In addition， two patients underwent cranial magnetic resonance imaging， and the results showed symmetrical long T₁ and long T₂ signals. All four patients received copper-chelating therapy and achieved a good outcome. This article reports the diagnosis and treatment of four patients with HLD and identifies a case of HLD resulting from a rare heterozygous mutation site， thereby expanding the variation spectrum of the ATP7B gene.

Objective To investigate the correlation between seasonal blood pressure （BP） variability and total burden score of cerebral small vessel disease （CSVD） with different severities. Methods The patients with CSVD who were consecutively admitted were enrolled， and according to the total burden score based on head MRI， they were divided into control group （CSVD 0 points）， mild group （CSVD 1‒2 points）， and moderate-to-severe group （CSVD 3‒4 points）.General information was collected from all patients， as well as 24-hour ambulatory blood pressure monitoring （ABPM） during warm and cold seasons. The correlation between ABPM parameters in different seasons and the imaging burden of different severities of CSVD was analyzed. Results A total of 145 patients were enrolled， with 29 patients in the control group，64 in the mild group， and 52 in the moderate-to-severe group.Compared with the control group， the mild group and the moderate-to-severe group had significantly higher age（F=9.721，P=0.001）， 24-hour systolic blood pressure （SBP） in hot season（F=6.572，P=0.002）， daytime SBP in hot season（F=6.460，P=0.002）， daytime diastolic blood pressure （DBP） in hot season（F=5.802，P=0.004）， nighttime SBP in hot season（F=8.508，P<0.001）. Compared with the control group， the moderate-to-severe group had significantly higher levels of 24-hour DBP in hot season（F=4.564，P=0.012）， nighttime DBP in hot season（F=6.294，P=0.002），24-hour SBP in cold season（F=7.012，P=0.001）， 24-hour DBP in cold season（F=4.527，P=0.012），daytime SBP in cold season（F=5.708，P=0.004），daytime DBP in cold season（F=3.138，P=0.046），nighttime SBP in cold season（F=9.154，P<0.001）， and nighttime DBP in cold season（F=8.006，P=0.001）. Compared with the control group， the mild group and the moderate-to-severe group had a significantly higher proportion of patients with abnormal BP circadian rhythm in hot season （χ²=13.059，P=0.001） and cold season （χ²=10.091，P=0.006）.The ordinal logistic regression analysis showed that age （OR=1.147， 95%CI 1.084‒1.214） was an independent risk factor for CSVD， and compared with the patients with dipper-type blood pressure in hot season， the patients with non-dipper blood pressure pattern had a risk of CSVD increased by 13.282 times （OR=13.282， 95% CI 2.379‒74.159）， while those with reverse-dipper blood pressure pattern had a risk of CSVD increased by 25.569 times（OR=25.569，95%CI 3.061‒213.551）. Conclusion The imaging burden score of CSVD increases with the increase in age and the proportion of abnormal circadian blood pressure pattern in hot season， and both age and abnormal circadian blood pressure pattern in hot season are independent risk factors for the imaging burden of CSVD.

Objective To investigate the value of total cerebral small vessel disease （CSVD） score combined with three-dimensional arterial spin labeling （3D-ASL） in predicting the prognosis of patients with acute ischemic stroke （AIS） after 90 days of intravenous thrombolysis. Methods A total of 189 AIS patients who were consecutively admitted to Department of Neurology， Changshu Hospital Affiliated to Nantong University， from January 2021 to June 2023 and underwent intravenous thrombolysis with alteplase were enrolled， and multimodal brain MRI was performed to assess total CSVD load and cerebral blood flow in the area of responsibility. A multivariate logistic regression analysis was used to identify the independent influencing factors for poor 90-day prognosis in AIS patients undergoing intravenous thrombolysis. The receiver operating characteristic （ROC） curve was used to investigate the value of total CSVD score and 3D-ASL used alone or in combination in predicting the prognosis of AIS. Results The multivariate regression analysis showed that diabetes （OR=3.601，95%CI 1.448‒8.954，P=0.006）， total CSVD score ≥3 points （OR=4.077， 95%CI 1.785‒9.313，P=0.001）， and baseline NIHSS score （for every 1-point increase：OR=1.167， 95%CI 1.061‒1.283， P=0.001） were independent risk factors for poor prognosis in AIS patients on day 90 after intravenous thrombolysis，while ASL hyperperfusion was an independent protective factor against poor prognosis （OR=0.16， 95%CI 0.050‒0.356，P=0.014）.The ROC curve analysis showed that the predictive model based on CSVD score and ASL perfusion had a C-value of 0.844 （95%CI 0.786‒0.902， P<0.05） and thus had the best predictive efficacy. Conclusion Total CSVD score combined with 3D-ASL can more comprehensively reflect the whole brain circulation network and has a better effect than each indicator alone in predicting the 90-day prognosis of AIS patients undergoing intravenous thrombolysis.

Objective To investigate the association of the total burden of cerebral small vessel disease （CSVD） with the level of tumor necrosis factor-α（TNF-α） and prognosis in patients with ischemic stroke （AIS）. Methods A total of 120 patients with AIS who were admitted to our hospital from January 2022 to December 2023 were enrolled as subjects， and all patients underwent cranial MRI scanning. Baseline data and TNF-α level were compared between the patients with different total burden scores of CSVD， and the correlation between TNF-α level and CSVD total burden score was analyzed. TNF-α level and CSVD total burden score were compared between the AIS patients with different prognoses to investigate the influence of TNF-α and CSVD total burden score on the short-term prognosis of AIS， as well as their value in predicting the short-term prognosis of AIS. Results There were significant differences in age， the proportion of patients with hyperlipidemia， the proportion of patients with smoking， and the levels of TNF-α and Hcy between the patients with different CSVD total burden scores （P<0.05）. The level of TNF-α was positively correlated with the number of lacunar cerebral infarcts， Fazekas score of white matter lesions， and EPV score （r=0.654， 0.775， 0.820， P<0.05）， but it had no linear correlation with the number of cerebral microbleeds （r=-0.035，P>0.05）. The logistic regression analysis showed that before correction， age， hyperlipidemia， smoking， TNF-α，and Hcy were significantly correlated with lacunar infarction， white matter lesions， EPV severity， cerebral microbleeds，and CSVD total burden score （P<0.05）， and after correction， TNF-α was still significantly correlated with lacunar infarction， white matter lesions，cerebral microbleeds， EPV severity， and CSVD total burden scores （P<0.05）. There were significant differences in CSVD total burden score and TNF-α between the patients with a good prognosis and those with a poor prognosis（P<0.05）.TNF-α combined with CSVD total burden score had the largest area under the receiver operating characteristic curve（AUC） of 0.912 in predicting the short-term prognosis of AIS，which was significantly higher than the AUC of TNF-α or CSVD total burden score used alone（P<0.05）. Conclusion The increase in TNF-α level has a certain relationship with CSVD total burden score and short-term prognosis in AIS patients， and the combination of TNF-α level and CSVD total burden score has a relatively high clinical application value in predicting the short-term prognosis of AIS patients.

Objective To systematically evaluate the association between obstructive sleep apnea （OSA） and the radiological features of cerebral small vessel disease （CSVD）， to investigate the potential mechanism of OSA in the development and progression of cerebrovascular diseases， and to provide a new scientific basis for optimizing clinical management strategies. Methods The patients with first-episode ischemic stroke and CSVD who were admitted from May 2021 to October 2023 were enrolled according to the inclusion and exclusion criteria. Cranial MRI was performed to evaluate the radiological features of CSVD， and sleep respiration testing was conducted to calculate hypoxic burden （HB）， a specific indicator for OSA， which was compared with traditional indicators. The multivariate logistic regression analysis was used to investigate the association between these hypoxic indicators and CSVD， and the receiver operating characteristic （ROC） curve was plotted to compare the correlation between hypoxic indicators and outcome measures. Results A total of 243 patients with first-episode acute ischemic stroke were enrolled in this study， among whom there were 155 male patients （63.8%） and 88 female patients. The multivariate logistic regression analysis showed that both HB OR=1.037， 95%CI 1.020-1.055， P<0.001） and apnea-hypopnea index （AHI）（OR=1.044， 95% CI 1.020-1.070， P<0.001） were significantly positively correlated with white matter hyperintensities （WMH）.The ROC curve analysis showed that the correlation between HB and WMH （AUC=0.722） was better than that between HB and AHI（AUC=0.670）. However， sleep time with oxygen saturation below 90% and oxygen desaturation index were not associated with WMH. OSA was not associated with enlarged perivascular spaces， cerebral microbleeds， or lacunar infarction. Conclusion Compared with traditional indicators， HB has a stronger correlation with WMH and can be used as a more effective indicator for risk assessment in OSA patients， thereby providing a precise basis for individualized intervention.

Objective To investigate the application value of occupational therapy in cognitive impairment in patients with cerebral small vessel disease. Methods A total of 84 patients with cerebral small vessel disease who were admitted to our hospital from April 2021 to September 2022 and were found to have cognitive impairment were enrolled as subjects， and they were randomly divided into observation group and control group using a random number table， with 42 patients in each group. The patients in the control group received conventional Western medicine treatment， while those in the observation group received occupational therapy in addition to the treatment in the control group. After 8 weeks of continuous treatment， the two groups were compared in terms of treatment outcome， Mini-Mental State Examination （MMSE） score， Montreal Cognitive Assessment （MoCA） score， brain-derived neurotrophic factor （BDNF）， high-sensitivity C reactive protein （hs-CRP）， homocysteine （Hcy）， and cerebral blood perfusion parameters. Results The treatment group had a higher overall response rate than the control group （95.24% vs 73.81%， P<0.05）. After treatment， the observation group had significantly higher MMSE， MoCA， and MBI scores than the control group （P<0.05）. Compared with the control group， the observation group had a significantly lower MTT and significantly higher CBV and CBF （P<0.05）. Compared with the control group， the observation group had a significantly higher level of BDNF and significantly lower levels of hs-CRP and Hcy （P<0.05）. Conclusion Occupational therapy has a marked clinical effect in patients with cerebral small vessel disease and cognitive impairment and can effectively improve cognitive function and cerebral blood perfusion， upregulate the level of BDNF， and reduce the expression of hs-CRP and Hcy. It is of great significance for improving the quality of life and prognosis of patients.

Objective To investigate the association between motoric cognitive risk syndrome （MCR） and neuroimaging markers in patients with cerebral small vessel disease （CSVD）， to assess the imaging markers associated with MCR， and to compare the differences in imaging markers between MCR and mild cognitive impairment （MCI）. Methods A retrospective study was conducted among 187 patients with CSVD who were admitted to Department of Neurology， Hebei Medical University Third Hospital， from April 2023 to November 2024， and they were divided into groups based on whether they were diagnosed with MCR or MCI. Clinical and imaging data were collected， and the univariate and multivariate logistic regression analyses were used to investigate the imaging features of CSVD patients with MCR. Results Compared with the MCR-negative group， the MCR-positive group had significantly higher BMI， proportion of male patients，and proportion of patients with hypertension， lacunar infarcts， severe white matter hyperintensity （WMH）， severe enlarged perivascular space （EPVS） in the basal ganglia， and high CSVD total burden （P<0.05）. The multivariate logistic regression analysis showed that the total volume of WMH was an independent risk factor for MCR in CSVD patients（OR=1.038，95%CI 1.003‒1.075，P=0.033）. Stratification by MCI，MCR showed that compared with the other groups， the MCI+/MCR+ group had a significantly higher proportion of patients with hypertension （the MCI-/MCR+ group had a higher proportion of patients with hypertension than the MCI+/MCR- group）， a significantly higher total volume of WMH， a significantly higher proportion of patients with severe deep brain and paraventricular WMH， and a significantly higher proportion of patients with severe EPVS（P<0.05）.Compared with the MCI+/MCR-group， the MCI-/MCR+ group had significantly higher grades （a significantly higher proportion of patients with grade 2 or 3 WMH than the MCI+/MCR- group） and total volume of periventricular and deep WMH（P<0.05）. There was no significant difference in CSVD total burden between groups（P>0.05）. Conclusion WMH is an independent risk factor for MCR in patients with CSVD. MCR is associated with a larger volume of WMH.This study highlights white matter abnormalities in MCR and the potential of motor function assessment in early risk stratification for dementia.

Objective To explore the changes in serum lactate dehydrogenase （LDH）， monocyte chemoattractant protein-1 （MCP-1）， and transcription factor 4 （TCF4） levels in patients with cerebral small vessel disease complicated by depression and their clinical significance. Methods According to the inclusion and exclusion criteria， 90 patients admitted to the Kailuan General Hospital between January 2022 and August 2024 were selected as the study subjects， including 27 patients diagnosed with cerebral small vessel disease complicated by depression and 63 patients with cerebral small vessel disease uncomplicated by depression. An additional 45 healthy individuals with normal head MRI findings and no mental disorders during the same period at the hospital were selected as the control group. General information was collected from the three groups， including age， body mass index， systolic blood pressure， and diastolic blood pressure.The general information and the levels of serum LDH，MCP-1，and TCF4 in the three groups were compared. The correlations of serum LDH，MCP-1，and TCF4 levels with HAMD score in patients with cerebral small vessel disease and depression were analyzed. Logistic regression was applied to analyze possible factors leading to depression in patients with cerebral small vessel disease.The receiver operating characteristic curve was applied to analyze the efficacy of serum LDH， MCP-1， and TCF4 levels in diagnosing depression in patients with cerebral small vessel disease. Results The levels of serum LDH， MCP-1，and TCF4 were significantly higher in the cerebral small vessel disease complicated by depression group than in cerebral small vessel disease uncomplicated with depression group and the control group （P<0.05）， and these levels were significantly higher in the cerebral small vessel disease uncomplicated with depression group than in the control group （P<0.05）.The serum LDH，MCP-1 and TCF4 were positively correlated with HAMD score in patients with cerebral small vessel disease complicated with depression（r=0.606，0.798，0.672，all P<0.001）.Serum LDH， MCP-1， and TCF4 were influencing factors for depression in cerebral small vessel disease（P<0.05）.The area under the receiver operating characteristic curve of LDH， MCP-1，and TCF4 in combination in the diagnosis of depression in cerebral small vessel disease was 0.917， which was superior to serum LDH， MCP-1， and TCF4 alone （Z_{LDH-combination}=2.457，P=0.014；Z_{MCP-1-combination}=2.384， P=0.017； Z_{TCF4-combination}=2.317， P=0.021）. Conclusion Serum LDH， MCP-1， and TCF4 levels increased in patients with cerebral small vessel disease complicated with depression. Their combination is valuable in the diagnosis of cerebral small vessel disease complicated with depression.

Objective To investigate the association between fibrinogen-to-albumin ratio （FAR） and the overall burden of cerebral small vessel disease （CSVD）， as well as their value in predicting early neurological deterioration （END） in patients with acute ischemic stroke （AIS）. Methods A total of 103 AIS patients who were admitted to our hospital from January 2023 to March 2025 were enrolled. According to the CSVD total burden score， the patients were divided into low burden group （0-2 points） with 58 patients and high burden group （3-4 points） with 45 patients； According to the presence or absence of END， they were divided into END group with 21 patients and non-END group with 82 patients. The weighted generalized additive model combined with smooth curve fitting was used to investigate the correlation between FAR and CSVD total burden score. A logistic regression analysis was used to explore the association of FAR and CSVD total burden score with the prognosis of END in AIS patients. The receiver operating characteristic （ROC） curve was used to assess the value of FAR and CSVD total burden score in predicting END in AIS patients. The restricted cubic spline method was used to analyze the dose-response relationship between FAR and END in AIS patients. The Bootstrap method was used to investigate the mediating effect of CSVD total burden score in the relationship between FAR and END in AIS patients. Results The high burden group had a significantly higher FAR than the low burden group （P<0.05）， and there was a U-shaped relationship between FAR and CSVD total burden score， with an inflection point of 8.14%. Compared with the non-END group， the END group had a significantly higher proportion of patients with a CSVD total burden score of 3-4 points and a significantly higher FAR （P<0.05）. After adjustment for the covariates such as age and sex， FAR （OR=1.918， 95%CI 1.825‒2.157，P<0.05） and CSVD global burden score （OR=2.167，95%CI 2.051‒2.249， P<0.05） were still independently associated with the risk of END in AIS patients. FAR combined with CSVD total load score had a significantly higher predictive value than either indicator alone， with an area under the ROC curve of 0.951. The mediating effect analysis showed that CSVD total burden score played a mediating effect between FAR and AIS patient prognosis END （P<0.05）. Conclusion There is a significant association between FAR and the overall burden of CSVD， and combined measurement of FAR and CSVD total burden score can significantly enhance the performance in predicting END， thereby providing an important basis for developing individualized treatment strategies in clinical practice.

Objective Excessive cerebral microbleeds（CMB）are a critical risk factor for cognitive impairment in cerebral small vessel disease（CSVD），yet their neuroimaging mechanisms remain unclear. By using multivariate divergence among multi-contrast MRI features， this study constructs a morphometric inverse divergence （MIND） networks to reveal the pattern of CMB-related structural disruption at the network level and investigate the potential imaging mechanisms of cognitive impairment. Methods A total of 69 CSVD patients with CMB were enrolled as CSVD-c group， 61 patients without CMB were enrolled as CSVD-n group， and 66 healthy controls （HC） were enrolled as HC group. MIND network topology was compared between the three groups， and the correlation between network abnormalities and neuropsychological parameters was analyzed. Results At the cognitive domain level， CSVD patients showed global cognitive decline， significantly affecting multiple domains including memory，visuospatial ability， executive function， and language. Compared with the HCs， CSVD patients had reductions in MIND strength in the frontal lobe （left area 9a and right p32） and the right temporal lobe （Mβ and Pβ），as well as increases in the extent and severity of CMB. For global topology， the patients with CSVD showed significant reductions in global and local efficiency and a significant increase in shortest-path length， with significantly greater changes in the CSVD-c group； for regional topology， there was a significant reduction in nodal efficiency in right Mβ. The correlation analysis showed that global and local efficiency and shortest-path length were significantly correlated with the scores of global cognition and multiple cognitive domains. Network-based statistic further revealed diminished connectivity within the default-mode network （DMN） and between DMN and visual/sensorimotor networks in the CSVD-c group. Conclusion CMB not only exacerbate global cognitive decline in CSVD patients，but also significantly affect multiple cognitive domains including memory， visuospatial ability， executive function， and language.Characteristic network alterations， including reduced synchrony in fronto-temporal regions， impaired global network efficiency and local temporal lobe efficiency， and weakened DMN-related connectivity，may be the potential mechanisms by which CMB aggravate cognitive impairment in CSVD.

Objective White matter hyperintensity（WMH） is the core imaging marker for cerebral small vessel disease， and gait disturbance induced by WMH is a major cause of functional disability in middle-aged and elderly populations. Existing studies mostly focus on the static association between WMH and gait disturbance， while time-varying characteristics are observed in the functional connectivity of brain networks. The dynamic functional connectivity（dFC） technique can capture the real-time interaction characteristics of brain networks， providing a new perspective for analyzing the neural mechanism of WMH-related gait disturbance. This study aims to investigate the neuroimaging mechanism of patients with WMH and gait disturbance using the dFC technique and clarify the association of dynamic brain network imbalance with motor function and cognitive function. Methods Subjects were recruited in Nanjing Drum Tower Hospital from 2023 to 2025， and after screening based on inclusion and exclusion criteria， 93 subjects were enrolled in the group of WMH with gait disturbance （WMH-GD group）， 86 subjects were enrolled in the group of WMH without gait disturbance （WMH-nGD group）， and 92 subjects were enrolled in the normal control group （NC group）. Background data collection， neuropsychological assessment， gait testing， and cranial magnetic resonance imaging （MRI） scanning were performed for all subjects. The DynamicBC toolbox was used to perform the dFC analysis and extract the dynamic indicators including fractional windows（F）， mean dwell time （MDT）， number of transitions（NT）， and transition probability （TP）； network-based statistics（NBS） were used to identify differential connectivity between brain regions across groups； the correlation analysis was used to investigate the correlation between dynamic indicators and clinical parameters. Results The cluster analysis identified two brain functional connectivity states， i.e.， State Ⅰ （sparse and weak connectivity， accounting for 61.29%） and State Ⅱ （dense and strong connectivity， accounting for 38.71%）. Inter-group comparisons showed that compared with the WMH-nGD group， the WMH-GD group had significantly higher F value （72.48% vs 57.38%， P<0.05） and MDT （95.47 windows vs 54.46 windows， P<0.05） of State Ⅰ and a significantly lower value of NT （2.44 times vs 3.83 times）， as well as a significantly lower value of TP from State Ⅱ to State Ⅰ （TP Ⅱ→Ⅰ： 2.61% vs 5.84%， P<0.05） and a significantly higher value of TP from State Ⅱ to State Ⅱ （TP Ⅱ→Ⅱ：97.39% vs 94.16%， P<0.05）. The NBS analysis showed that compared with the WMH-nGD group， the WMH-GD group had a significant reduction in inter-regional connectivity between the occipital lobe， the parietal lobe， and the frontal lobe in State Ⅰ and a significant increase in connectivity within subcortical brain regions and between the limbic lobe and the subcortical region. The correlation analysis showed that in the WMH-GD group， Mini-Mental State Examination score was negatively correlated with MDT of State Ⅰ and TP Ⅱ→Ⅱ and was positively correlated with TP Ⅱ→Ⅰ and NT， and gait speed was positively correlated with NT. Conclusion Dynamic brain network imbalance is observed in patients with WMH and gait disturbance， which manifests as rigidity of the sparse and weak connectivity state， a reduction in transition flexibility， and reorganization of cortex-subcortex connectivity. These abnormalities are closely associated with cognitive and gait functions， suggesting that disruption of brain network metastability may be one of the core neural mechanisms underlying WMH-related gait disturbance.

Objective To investigate the change in morphometric similarity gradient in patients with white matter hyperintensity （WMH）-related cognitive impairment and its influence on cognitive function. Methods Baseline and neuroimaging data were collected from 141 healthy controls （HC group）， 66 patients with WMH and normal cognition （WMH-NC group）， and 134 patients with WMH and cognitive impairment （WMH-CI group）. The difference in gradient was compared between groups based on the morphometric similarity gradient analysis. The mediating effect model was used to investigate the association between WMH volume，plasma biomarkers for nerve injury， gradient， and cognitive function. Results The research findings showed significant aberrant alternations in morphometric similarity gradient， with a significant increase in variability in the second gradient （P=0.036， not surviving FDR correction）. There was a significant negative correlation between the second gradient and geodesic distance （P_spin<0.001）. In addition，visual cortex gradient played a key mediating role in the association between p-tau₁₈₁/WMH volume and visuospatial function. Conclusion Patients with WMH-related cognitive impairment have aberrant macroscopic connectivity patterns of the cortex. The aberrant pattern of regional cortex mediates the process in which p-tau₁₈₁ and WMH volume affect cognitive function， which provides a new perspective for understanding the potential structural mechanism of WMH-related cognitive impairment.

Cerebral small vessel disease （CSVD） has a high incidence rate， an insidious onset， a heterogeneous etiology， and serious damage. At present， there are still various critical issues in the clinical diagnosis and treatment of CSVD， including the difficulty in early warning， difficult etiological typing， and limited treatment methods. This article summarizes the clinical studies on the diagnosis and treatment of CSVD in recent years， in order to provide a reference for solving problems in diagnosis and treatment.