Evaluation of silent cerebral ischemia and cognitive functions in young and middle- aged patients with metabolic syndrome

Aim: Metabolic syndrome (MetS) risk factors and accompanying silent cerebral ischemia (SCI) may cause cognitive decline. The aim of this study is to investigate the characteristics and association between SCIs and cognitive functions in young and middleaged patients with MetS. Methods: A total of 91 patients who were aged between 20-60 years with a diagnosis of metabolic syndrome were prospectively enrolled. Silent cerebral infarcts (SCIs) were analyzed by performing 3 Tesla magnetic resonance imaging (MRI) of the brain. Attention and executive functioning were assessed with the Wechsler Adult Intelligent scale-Revised (WAIS-R), verbal fluency, Stroop, and clock drawing test. Wechsler Memory Scale-Revised (WMS-R) visual reproduction and Öktem verbal memory processes tests were conducted to determine visual and verbal memory performance, whereas visuospatial functions were evaluated by the Benton judgment of line orientation test. Results: Diagnosis of hypertension and diabetes mellitus were significantly higher, while educational level was lower in patients with SCIs than without SCIs. (p <0.001, p=0.034, p=0.05, respectively). Cognitive test scores regarding attention and executive functioning, verbal, visual, and visuospatial memory showed no significant difference between patients with SCIs and without SCIs. However, hyperhomocysteinemia was negatively correlated with executive functions in MetS patients with SCI (p= 0.038). Conclusions: SCIs may be associated with hypertension and diabetes mellitus in young and middle-aged patients with MetS. In addition, controlling homocysteine levels might be beneficial in MetS patients with SCI in terms of improving cognitive functions.