Cognitive Impairment in Patients with Degenerative Cervical Myelopathy

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.