Aneurysm Wall Enhancement and Systemic Inflammation Jointly Contribute to Cognitive Dysfunction in Untreated Unruptured Intracranial Aneurysm Patients

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. 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. 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. 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.