To investigate the characteristics and relationship between cerebral blood flow (CBF) and cognitive impairment in patients with general paralysis of the insane (GPI).

Total of 18 patients with GPI (GPI group) and eighteen healthy controls (HC group) were enrolled from January 2018 to December 2019 in Beijing Ditan Hospital, Capital Medical University. The cognitive function was assessed by montreal cognitive assessment (MoCA). The cerebral blood flow was evaluated by arterial spin labeling, and the relationship between cerebral blood flow and cognitive function was analyzed by Spearman correlation analysis.

The MoCA score of patients with GPI was significantly lower than that of HC group [(16.00 ± 7.19) vs. (27.90 ± 1.21): t = -7.853, P < 0.001]. Among GPI group, 5 cases had normal brain MRI, 1 case had white matter lesions, 9 cases had brain atrophy, and 3 cases had brain atrophy and white matter lesions at the same time. No abnormality head MRI was found in HC group. The cerebral blood flow in 13, 14, 28, 37, 38, 41, 42, 43, 44, 46, 48, 49, 50, 51, 52, 69, 70, 77, 78, 83, 84, 88, 109, 117, 165, 166, 167, 168, 169, 177, 178, 179, 187, 188, 211, 212, 213, 214, 215, 216, 219, 223, 227, 237 and 238 brain regions in the patients with GPI were significantly higher than those of HC group (all P < 0.001). There were negative correlations between lack of concentration and high CBF in 69, 70, 77, 78, 166 and 168 brain regions (r = -0.476, P = 0.046; r =-0.487, P = 0.034; r =-0.604, P = 0.008; r =-0.545, P = 0.019; r =-0.544, P = 0.02; r =-0.522, P = 0.026).

The whole brain blood flow increased in patients with GPI. Concentration may be related to the increase of regional CBF; the higher the regional CBF, the more severe the attention disorder. This may be one of the pathogenesis of GPI.