Non-Invasive Screening for Early Cognitive Impairment in Elderly Hyperuricaemic Men Using Transcranial Colour-Coded Duplex Sonography

Abstract

Objectives: Hyperuricaemia has been linked to cognitive decline, yet cerebral structural and haemodynamic changes in this population remain poorly defined. We evaluated transcranial colour-coded duplex (TCCD) sonography as a non-invasive screening tool for early mild cognitive impairment (MCI) in elderly hyperuricaemic men. Methods: In this cross-sectional study, 195 men aged ≥ 60 years with hyperuricaemia were stratified by the Montreal Cognitive Assessment (MoCA) into HUA + MCI (MoCA < 26, n = 46) and HUA (MoCA ≥ 26, n = 149) groups. TCCD measured third-ventricle width (TVW) and peak systolic/end-diastolic velocities to calculate resistive (RI) and pulsatility (PI) indices in the middle (MCA) and posterior (PCA) cerebral arteries. Serum uric acid was recorded. Kernel density plots and receiver operating characteristic (ROC) curves assessed diagnostic performance. Results: The HUA + MCI group exhibited higher serum uric acid (508.5 ± 36.3 vs. 492.9 ± 44.0 µmol/L; p = 0.031), greater TVW (0.55 ± 0.11 vs. 0.51 ± 0.08 cm; p = 0.037), and elevated left PCA RI (0.69 ± 0.07 vs. 0.64 ± 0.06) and PI (1.05 ± 0.17 vs. 0.95 ± 0.12; both p < 0.001). ROC analysis identified left PCA PI as the most specific marker (AUC = 0.701; specificity 90.6%; sensitivity 45.7%). Kernel density plots confirmed distinct distributions of key parameters. Conclusions: TCCD-detected ventricular enlargement and raised PCA pulsatility accurately distinguish MCI among hyperuricaemic men. As a non-invasive, accessible technique with high specificity, TCCD may complement MRI and cognitive testing in early screening of at-risk populations.

Keywords: cerebral haemodynamics; hyperuricaemia; mild cognitive impairment; third ventricle width; transcranial colour-coded duplex.

Figure 1

TCCD axial image at the mesencephalic plane. (a) indicates the insonation site used for measuring the haemodynamic parameters of the left proximal M1 segment of the MCA, and (b) indicates the site used for the left P1 segment of the PCA.

Figure 2

Kernel density distribution plots comparing clinical and transcranial colour-coded duplex (TCCD) parameters between hyperuricaemia patients with and without mild cognitive impairment (MCI). Each subplot (a–x) represents a specific variable: (a) Age, (b) Hypertension, (c) Diabetes, (d) Hyperlipidaemia, (e) Serum uric acid, (f) Duration of hyperuricaemia, (g) Body mass index (BMI), (h) Third ventricle width (TVW), (i–l) Left middle cerebral artery (MCA): (i) PSV, (j) EDV, (k) RI, (l) PI; (m–p) Right MCA: (m) PSV, (n) EDV, (o) RI, (p) PI; (q–t) Left posterior cerebral artery (PCA): (q) PSV, (r) EDV, (s) RI, (t) PI; (u–x) Right PCA: (u) PSV, (v) EDV, (w) RI, (x) PI. The blue curves represent the cognitively normal HUA group, while the orange curves represent the HUA + MCI group. Statistically significant differences were observed in serum uric acid (e), third ventricle width (h), and left PCA resistive index (s) and pulsatility index (t), all with p-values < 0.05. Other parameters, including MCA measurements and systemic comorbidities, did not show significant intergroup differences (all p > 0.05). These distributions highlight the specific TCCD and clinical variables that distinguish cognitive status in hyperuricaemic individuals. Note: * p < 0.05; *** p < 0.001.

Figure 3

ROC curves for identifying MCI in hyperuricaemic patients using serum uric acid, TVW, and TCCD-derived indices from the left PCA. Serum uric acid showed modest discrimination (AUC = 0.613), while TVW had a similar performance (AUC = 0.616). Left PCA RI and PI demonstrated higher diagnostic accuracy, with AUCs of 0.699 and 0.701, respectively. Among all parameters, left PCA PI and RI showed the highest specificity. The diagonal line indicates the line of no discrimination.