Spine - 2026-05-04 - Journal Article
Cognitive Impairment in Patients with Degenerative Cervical Myelopathy: A Cross-Sectional Comparative Study and Its Correlation with Spinal Cord Compression.
Li H, Cui J, Wu J, Ge Y, Yang G, Yu R, Zhang Z, Wang H, He D
Topics
Key Takeaway
DCM patients scored significantly lower on MoCA (20.61 ± 3.76) and MMSE (26.23 ± 2.84) than both CSR patients and healthy controls, with MSCC negatively correlated with cognitive scores (MoCA r = -0.218, MMSE r = -0.237 in single-level disease).
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Summary
This cross-sectional study asked whether DCM patients demonstrate measurable cognitive impairment compared to CSR patients and healthy controls, and whether radiographic compression severity correlates with cognitive performance. After propensity-score matching for age, sex, and education, DCM patients scored significantly lower on MoCA and MMSE than both comparator groups across all age and education strata. MSCC correlated negatively with MoCA and MMSE, with the strongest associations in single-level DCM (r = -0.218 and -0.237, respectively), while number of compressed segments did not influence global cognition.
Key Limitation
Cross-sectional design cannot establish causality or determine whether surgical decompression reverses the observed cognitive deficits, which is the clinically decisive question.
Original Abstract
STUDY DESIGN
A cross-sectional study.
OBJECTIVE
This study aimed to investigate cognitive impairment in degenerative cervical myelopathy (DCM) and examine its relationship with radiographic spinal cord compression.
SUMMARY OF BACKGROUND DATA
Degenerative cervical myelopathy is a leading cause of chronic non-traumatic spinal cord injury. While its motor and sensory manifestations are well established, the potential impact on cognitive function remains underexplored.
METHODS
A total of 965 participants were enrolled: 383 DCM patients (Group A), 122 cervical spondylotic radiculopathy (CSR) patients (Group B), and 460 healthy controls (Group C). Cognitive performance was evaluated with the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and the Basic Cognitive Aptitude Test (BCAT). Propensity-score matching (A:B:C=2:1:2) was used to balance age, sex, and education; additional stratified analyses by age (≤50, 51-60, 61-70, and >70 years) and education (≤6, 7-12, and ≥13 years of education) were performed. Compression ratio (CR) and maximum spinal cord compression (MSCC) were measured on cervical MRI. Correlation analyses were used to explore the association between radiographic spinal cord compression and cognitive function.
RESULTS
After matching, DCM patients exhibited significantly lower MoCA (20.61 ± 3.76) and MMSE (26.23 ± 2.84) scores than both CSR and control group (all P < 0.001); this disadvantage persisted across every age and educational stratum. MSCC correlated negatively with MoCA (r = -0.118, P = 0.022) and MMSE (r = -0.124, P = 0.017), with stronger associations in single-level DCM (MoCA r = -0.218, P = 0.008; MMSE r = -0.237, P = 0.004). The number of compressed segments did not influence global cognition.
CONCLUSION
Cognitive impairment is significantly associated with DCM, which is influenced by age, education, and the degree of spinal cord compression.