Xiao-Bing Wu,1,* Bin Luo,2,* Xin Guo,2,* Chi-Chen Liu,2 Yi-Ao Liu,2 Jie-Shun Ye,3 Shao-Yi Fan,4 Qing-Jian Li,5 Sheng-Wen Wang1 

1Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China; 3School of Civil Engineering and Transportation, South China University of Technology, Guangzhou, People’s Republic of China; 4Department of TCM, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 5Department of Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Sheng-Wen Wang, Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang West Road, Guangzhou, Guangdong, 510120, People’s Republic of China, Email wangshw9@mail.sysu.edu.cn Qing-Jian Li; Department of Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang West Road, Guangzhou, Guangdong, 510120, People’s Republic of China, Email liqj33@mail.sysu.edu.cn

Background and Purpose: Peripheral inflammatory markers and aneurysm wall enhancement (AWE) on high-resolution vessel wall MRI (HR-VWI) may reflect inflammation in unruptured intracranial aneurysms (UIAs). We assessed cognitive function and its association with inflammatory markers in UIA patients.
Methods: The study included 120 consecutive patients with UIAs diagnosed between September 2018 and December 2023 and a control group of 27 healthy adults at our institution. Neuropsychological function in these patients was evaluated using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety Scale (HAMA), and Self-Rating Depression Scale (SDS). A MoCA score of < 23 was classified as cognitive decline, while scores of ≥ 23 indicated normal cognitive function. The peripheral blood inflammatory markers and radiological characteristics were compared between the patients with cognitive decline and those with normal cognitive function. The presence of AWE and white matter hyperintensities (WMH) in UIA was identified through HR-VWI.
Results: UIA patients demonstrated significantly poorer cognitive performance than controls, with lower MMSE (27.0 vs 29.0, P < 0.001) and MoCA scores (23.0 vs 25.0, P = 0.020). Patients with cognitive decline were older and exhibited elevated inflammatory markers (NLR, SII, hsCRP; all P < 0.05), along with higher rates of AWE and white matter hyperintensities (WMH) (both P < 0.001). Multivariate analysis identified AWE (OR = 5.33, 95% CI:1.82– 15.59), WMH (OR = 4.26, 95% CI:1.58– 11.49), and age (OR = 1.07, 95% CI:1.02– 1.12) as independent predictors of cognitive decline (all P ≤ 0.01). Moreover, the cognitive decline group also showed higher SDS and HAMA scores (P < 0.05), suggesting a correlation between emotional distress and cognitive impairment.
Conclusion: Untreated UIA patients exhibit cognitive decline associated with systemic inflammation (NLR, SII, hs-CRP). AWE, WMH and age are independent risk factors, suggesting vascular inflammation contributes to cognitive dysfunction.

Keywords: unruptured intracranial aneurysm, cognitive function, aneurysm wall enhancement, inflammation