白质疏松对脑梗死患者认知功能的影响

目的探讨白质疏松对脑梗死患者认知功能的影响。方法采用MMSE量表评分追踪观察95例脑梗死患者，其中认知障碍组27例，无认知障碍组68例。结果经Logistic回归发现白质疏松（OR=3．444．95％CI=[1．137-10．425]）和脑梗死史（OR=3．254，95％CI=[1．180-8．975]）是认知障碍的独立危险因素。发病初期白质疏松组MMSE评分明显低于非白质疏松组，在发病1个月及3个月时的MMSE评分差值比较无显著差异，而在6个月及以后的评分中2组评分差值存在差异，白质疏松组的MMSE评分差值明显小于非白质疏松组，且白质疏松组MMSE评分下降。结论白质疏松和脑梗死史是脑梗死患者认知障碍的独立危险因素；白质疏松在脑梗死后会加重患者的认知障碍。     

白质疏松与脑梗死后意识状态的关系

目的探讨白质疏松与脑梗死后意识状态的关系。方法采用Glasgow昏迷量表评分追踪观察了138例脑梗死患者,白质疏松组78例,非白质疏松组60例。结果白质疏松(OR=5.294,95%CI=1.451-19.318)和OCSP分型(OR=14.489,95%CI=4.121-50.934)是影响意识障碍的独立危险因素。在发病初白质疏松组的意识障碍重于非白质疏松组,在发病1m和3m时,白质疏松组患者意识障碍的改善程度明显小于非白质疏松组。结论白质疏松在梗死早期加重意识障碍并影响意识的恢复。     

Binswanger病、脑白质疏松症及其合并脑梗死患者的认知功能障碍

目的　探讨Binswanger病 (BD)、脑白质疏松症 (LA)及LA合并脑梗死 (LA +CI)患者的认知功能障碍程度及其临床意义。方法　采用简易精神状态量表 (MMSE)和临床记忆量表 (CMS)检查BD(33例 )、LA(2 7例 )、LA +CI(31例 )患者及健康对照者 (30名 )的认知功能状态 ,并比较其障碍的程度。结果　 (1)BD组、LA组、LA +CI组MMSE及CMS评分均明显低于对照组 (P <0 0 5～ 0 0 1)。 (2 )BD组、LA +CI组MMSE及CMS评分均明显低于LA组 (P <0 0 5～ 0 0 1)。 (3)LA组轻度认知功能障碍 2 1例 (77 8% ) ;BD组中度认知功能障碍 8例 (2 4 2 % ) ,痴呆 2 5例 (75 .8% ) ;LA +CI组中度认知功能障碍 6例 (19 4 % ) ,痴呆 2 4例 (77 4 % )。结论LA大多有轻度认知功能障碍 ,而BD和LA +CI多为中度认知功能障碍和痴呆。认知功能障碍的程度是临床诊断BD、LA的参考指标。     

脑缺血相关的白质疏松对脑梗死预后的影响

目的 探讨脑白质疏松的危险因素及其对脑梗死预后的影响。方法 采用多组脑梗死相关量表评分追踪观察了138例脑梗死患者,其中白质疏松组78例,非白质疏松组60例。结果 经Logistic回归发现年龄[OR=1.043,95％CI=(1.008～1.080)]和高血压史[OR=1.289,95％CI=(1.003～1.6551)]是白质疏松的独立危险因素。白质疏松(OR=5.294,95％CI=1.451-19.318)和OCSP分型中的完全前循环梗塞(TACI)和后循环梗塞(POCI)类型(OR=14.489,95％CI=4.121～50.934)是影响意识障碍的独立危险因素。白质疏松组在卒中第6个月时的神经功能缺损程度评分差值明显小于非白质疏松组。在发病6个月以后,与非白质疏松组相比,白质疏松组的简式Fugl-Meyer运动评分差值明显变小。发病初白质疏松组的意识障碍不但重于非白质疏松组,且在发病3个月内其改善的程度也明显差于非白质疏松组。结论 白质疏松在发病早期对肢体功能的康复无影响,但会加重意识障碍并影响意识功能的恢复。而在发病6个月以后会延迟肢体功能的康复。白质疏松和OCSP分型中的TACI和POCI类型是影响意识障碍的独立危险因素。     

无症状脑白质疏松的MRI与临床研究

１０３例正常体检者及１５６例首次卒中入院病例的ＭＲＩ及临床资料研究发现无症状白质疏松（ＬＡ）２２例，两组发生率分别为６．７％和８．３％。本研究发现ＬＡ的主要原因是高龄、高血压动脉硬化，而与糖尿病等无明显关系。无症状ＬＡ可能是老年性痴呆的早期阶段，应认为是老年人群脑病损的标志。     

磁共振弥散张量成像与急性脑梗死患者认知功能的关系

目的 利用磁共振弥散张量成像(DTI)评估急性脑梗死患者的认知功能.方法 分别对30例急性脑梗死患者及30名健康志愿者进行DTI检查,观察兴趣区(ROIs)表观扩散系数(ADC)及部分各向异性(FA)的变化,同时评定患者的认知功能及神经功能缺损评分,分析内在的相关性.结果 脑梗死患者组梗死区FA值、ADC值(×10-3 mm2/s)明显下降,平均FA值、ADC值分别为0.12±0.01、1.08±0.11,其对侧相应部位平均FA值、ADC值为0.35±0.08、3.46±0.26,两者相比差异有统计学意义(P＜0.05);脑梗死患者健侧ADC、FA值与对照组相应部位对比差异无统计学意义.脑梗死同侧内囊后肢、大脑脚、皮质脊髓束与健侧相应部位相比,平均FA值明显下降(P＜0.05).脑梗死患者梗死区FA值、ADC值与认知功能呈正相关,与EDSS评分具有负相关性.结论 DTI与急性脑梗死患者认知功能具有一定的相关性,可为脑梗死患者认知功能障碍的早期诊断及早期治疗提供一些依据.     

脑白质疏松症伴轻度认知损害患者静息态功能磁共振成像研究

目的采用f MRI研究脑白质疏松症伴或不伴轻度认知损害患者静息态脑网络功能连接,探讨静息态fMRI对脑白质疏松症的早期诊断价值。方法共49例脑白质疏松症患者根据临床痴呆评价量表评分分为脑白质疏松症伴轻度认知损害组(LA-MCI组,34例)和脑白质疏松症不伴轻度认知损害组(LA-NMCI组,15例),采用简易智能状态检查量表、蒙特利尔认知评价量表、汉密尔顿抑郁量表17项和汉密尔顿焦虑量表14项评价认知功能、抑郁和焦虑症状,静息态f MRI研究脑网络功能连接。结果LA-MCI组患者年龄大于正常对照组(P=0.003),MMSE(P=0.001,0.000)和Mo CA(P=0.001,0.000)评分高于LA-NMCI组和正常对照组。与正常对照组相比,LA-MCI组患者突显网络内部核团功能连接减弱,突显网络对脑默认网络核团的功能连接呈增强趋势、对中央执行网络的功能连接呈减弱趋势;LA-NMCI组患者突显网络内部核团功能连接减弱,突显网络对脑默认网络核团的功能连接呈增强趋势、对中央执行网络核团的功能连接呈减弱趋势。结论脑白质疏松症伴或不伴轻度认知损害患者静息态激活脑区与正常人群存在差异,可以在一定程度上解释脑白质疏松症伴认知功能障碍的病理生理学机制。     

慢性失眠障碍患者认知功能与核磁共振波谱成像的研究

目的 探讨慢性失眠障碍(Chronic insomnia disorder,CID)患者的认知功能和海马氢质子磁共振波谱成像(Proton magnetic resonance spectroscopy,¹H-MRS)特点。方法 收集自2017年1月1日-2020年1月1日就诊于新疆医科大学第五附属医院睡眠障碍门诊的60例CID患者,对照组选取同期门诊体检的60例无睡眠障碍的健康人群; 采用匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评估2组研究对象的睡眠质量; 分别采用简易智力状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评估2组研究对象的总体认知功能; 应用¹H-MRS技术检测2组双侧海马N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)和肌酸(Cr)3种代谢物水平,并计算NAA/Cr和Cho/Cr比值。结果 CID组患者PSQI评分显著高于对照组(P<0.01); CID组MMSE评分与对照组比较无显著差异(P>0.05); CID组MoCA评分显著低于对照组(P<0.01),其中注意力、瞬时记忆、延时记忆以及视空间执行功能评分均显著低于对照组(P<0.01、0.01、0.01、0.05); CID组右侧海马NAA/Cr比值低于对照组(1.76±0.32 vs.2.06±0.48)(t=2.278,P=0.027); CID组双侧海马NAA/Cr比值无明显差异(t=1.425,P=0.168); C1D组患者PSQI总分及病程与MoCA评分呈负相关(r=-0.428,-0.355,P=0.006),与右侧海马NAA/Cr比值呈负相关(r=-0.352,-0.308,P=0.019)。结论 CID患者失眠严重程度及病程与MoCA评分、右侧海马NAA/Cr 比值有关,可能导致患者轻度认知功能障碍(MCI)及右侧海马可能存在神经元受损。     

白质疏松与血管性痴呆

随着脑部成像技术的进展,白质疏松(leukoariosis,LA)的检出率越来越高。目前对LA的临床意义以及是否可致血管性痴呆(vascular dementia,VD)尚有争论。本文仅就LA与VD的关系进行综述。1 概述 LA改变包括脑室扩大,脑室周围及皮质下深部白质改变,CT表现相应脑区低密度,MRI则表现为相应脑区的T1低信号、T2高信号,常可见腔隙梗塞(lacunar infarctions,     

老年脑梗死患者认知功能与头颅磁共振成像关系分析

目的探讨老年脑梗死患者梗死部位与认知功能障碍的相关性。方法对80例老年脑梗死患者依据《美国精神障碍诊断与统计手册》对认知功能障碍进行诊断,均用头颅磁共振检查明确病灶部位和范围;同时随机选择无明确梗死灶的80例老人为对照组。用中文版简易智能状态检查表和中文版蒙特利尔认知评估量表分别对两组患者认知功能做联合评估;半年后分别对以上患者复查其认知功能。结果脑梗死患者认知功能障碍的发生率为48.75%,脑梗死组侧别与对照组在认知功能上比较,脑梗死双侧组认识功能障碍发生率高于脑梗死单侧组,左侧脑梗死组认识功能障碍发生率高于右侧组。脑梗死患者中认识功能障碍发生率的次序由高到低为皮质组、丘脑组、基底节及内囊组、脑干组。结论脑梗死患者的认知功能障碍与病灶部位有相关性。     

Neurochemical correlates of cognitive dysfunction in patients with leukoaraiosis: a proton magnetic resonance spectroscopy study

Abstract

Objectives: Leukoaraiosis (LA) is a common radiological finding in the elderly and may reflect cerebral small vessel disease (SVD). Although SVD has been identified as a major cause of vascular cognitive impairment or vascular dementia, the mechanisms for this association remain unclear. We therefore aimed to measure brain metabolites in LA using proton magnetic resonance spectroscopy (¹H-MRS) as to determine the relationship between cognitive function and neurochemical white matter profile.

Methods: We recruited 23 patients with LA and 23 age- and sex-matched healthy controls consecutively. Multi-voxel ¹H-MRS was performed with a volume of interest located in centrum semiovale that contained mainly white matter voxels. Three main ratios of N-acetyl aspartate (NAA)/Cr, choline (Cho)/Cr and NAA/Cho were obtained. Spearman rank correlation coefficients were calculated between the cognitive function and the measured metabolite ratios.

Results: We found significantly lower levels of NAA/Cho and NAA/Cr ratios in lesioned white matter in patients with LA than healthy controls (P<0·05). The ratios of NAA/Cho and NAA/Cr in normal appearing white matter (NAWM) were higher than lesioned white matter and lower than controls, but this difference was not significant (P>0·05). There was a positive relationship between Mini-Mental State Examination (MMSE) and NAA/Cho in NAWM (r?=?0·417, P?=?0·048), and also a positive relationship between MMSE and NAA/Cr in lesioned white matter (r?=?0·551, P?=?0·006) in patients with LA. A positive relationship between the Z scores of the executive function and NAA/Cho in lesioned white matter (r?=?0·557, P?=?0·006) was also found.

Conclusion: The main finding of this study was a significant reduction in the ratios of NAA/Cr and NAA/Cho in lesioned white matter, which indicates a marker of neuronal loss or dysfunction in patients with LA, which was correlated with cognitive function. This relationship between cognitive function and metabolic changes suggests that ¹H-MRS can be explored as a marker for cognitive dysfunction in patients with LA.     

Mild cognitive impairment and event-related potentials in patients with cerebral atrophy and leukoaraiosis

Objective  The influence of cerebral atrophy and leukoaraiosis (LA) on the degree and profile of cognitive impairment remains unclear. Design  The aim of the study was to assess neuropsychological features of cognitive performance and parameters of event-related potentials (ERP) in subjects with generalised cerebral atrophy and LA. Setting  Department of Neurology, University of Medicine. Patients and participants  Forty-two patients with LA and/or cerebral atrophy and twenty controls. Measurements and results  Neuropsychological testing (NT) included Mini Mental State Examination (MMSE), Auditory Verbal Learning Test (AVLT) and Trail Making Test (TMT). Auditory ERPs were performed and parameters of the N2 and P3 components were compared in the patients and controls. Relationships were analysed between radiological indices of atrophy and LA, and NT and ERP results. Results of NT suggested generalised mild cognitive impairment in all the patients. P3 and N2 latencies were longer in the patients than in controls, especially in the LA subgroup. Correlations were found for indices of atrophy, AVLT and ERP parameters. There was a predominant influence of age upon ERP parameters and radiological indices. Conclusions  Cerebral atrophy and LA result in deficits in memory and attention. NT and ERP may be used as complementary methods in the assessment of cognitive impairment in patients with cerebral atrophy and LA.     

伴智能障碍的脑白质疏松症患者相关危险因素分析

目的分析伴智能障碍的脑白质疏松症(LA)患者的相关危险因素。方法 207例LA患者分为伴有智能障碍组和无智能障碍组,对患者的性别、年龄、高血压病史、糖尿病史、冠心病史及既往脑梗死病史等进行相关因素分析和Logistic回归分析。结果两组年龄、高血压病史、糖尿病史、既往脑梗死病史和LA的严重程度均有显著差异。多因素回归分析最终入选模型的变量是年龄、高血压病史、既往脑梗死病史和重度LA。结论高龄、高血压病史、既往脑梗死病史和重度LA,对LA是否伴智能障碍有独立的提示作用。     

老年脑白质疏松合并高血压对患者认知功能的影响

目的探讨老年脑白质疏松(LA)合并高血压对患者认知功能的影响。方法选取2014年1月~2015年1月期间于我院神经内科门诊就诊或病房收治的42例老年LA合并高血压患者为研究对象,归为老年LA伴高血压组,并选择同期40例无脑白质病变的单纯老年高血压患者归为老年高血压组,以及来我院体检的30例健康老年人作为老年健康对照组。以蒙特利尔认知评估量表(Mo CA)评估3组的认知功能。结果老年LA伴高血压组的视空间与执行功能、命名、注意力、抽象及延迟回忆的评分及总分均显著低于老年健康对照组,差异均有统计学意义(P0.05)。且视空间与执行功能、抽象的评分及总分均显著低于老年高血压组,差异有统计学意义(P0.05)。老年LA伴高血压组的认知功能损害发生率显著高于老年高血压组及对照组,差异均有统计学意义(P0.05)。结论与老年高血压和健康老人相比,老年LA合并高血压患者的认知功能明显减退,认知功能障碍率明显升高,故需要对这些老年患者定期检测认知功能,对认知功能障碍进行早期干预。     

Relation between MRI features and dementia in cerebrovascular disease patients with leukoaraiosis: A longitudinal study

We examined selective MRI features (localization and degree of white matter abnormalities, cortical and subcortical atrophy) in relation to cognitive decline in patients with cerebrovascular disease (CVD) and leukoaraiosis (LA). We enrolled 6 female and 18 male CVD patients (mean age 66.2 ± 6.6 years) whose Magnetic Resonance Images (MRI) revealed LA and who displayed a history of stroke or TIA; none showed signs of cortical infarcts or normal pressure hydrocephalus. Two blind raters independently scored MRI scans with a high level of agreement. All patients underwent extensive clinico-neuropsychological assessment upon admission to the study and 19 were followed for an average of 48 ± 7.6 months. Twelve patients were initially classified as non-demented and 12 as demented. Three years later, one in the former group had become demented and mental impairment had worsened for 6 patients in the latter group; these 7 subjects were labeled as “decliners”. Ventricular indexes were significantly higher in the demented group and correlated with severity of mental impairment, while the degree of LA was similar in demented and non-demented subjects. Neither white matter lesions nor sulcal and ventricular enlargement differed statistically between decliners and non-decliners.     

精神分裂症认知功能障碍功能磁共振成像研究的进展

精神分裂症是一种使人类严重丧失社会生活功能的疾病,影响了1%的世界人口,发病率和死亡率较高[1-2].精神分裂症通常发生在青春期或成年早期,约70%转为慢性精神分裂症[3].精神分裂症患者存在严重的认知功能障碍,疾病改变了患者的大脑结构和功能,对人的思维、注意力和协调性方面有很大影响[4],主要表现在注意、记忆和执行功能等方面[5].随着神经功能影像学的发展,很多功能影像相关的技术成为研究精神分裂症的重要方法.最初,科学家们利用功能影像学研究精神分裂症认知功能障碍与大脑各个脑功能区域的联系,试图通过建立多个脑区之间广泛地功能连接来更好地解释精神分裂症患者混乱的认知功能.功能磁共振成像(Functional Magnetic Resonance Imaging,fMRI)作为一种比较成熟的功能影像技术,广泛地被科研人员应用于精神分裂症患者认知功能损害的研究中,并取得了一定成果.这些成果为我们提供了对精神分裂患者的大脑进行更细微研究的一些理解,现将研究进展综述如下.     

脑白质疏松症患者认知功能与血浆生长抑素含量的变化

目的 探讨脑白质疏松症（LA）患者认知功能和血浆生长抑素（SS）含量的关系。方法 研究对象分为LA痴呆组26例,LA非痴呆组47例和正常对照组38例。3组均接受长谷川痴呆量表（HDS）评定及血浆SS含量的检测。结果 与对照组比较,LA患者（包括痴呆组和非痴呆组）HDS评分和血浆SS含量均明显下降（均P＜0．001）;LA痴呆组与LA非痴呆组比较,HDS评分也明显下降（P＜0．001）;血浆SS含量虽有下降,但没有显著差异（P＞0．05）。结论 LA可影响认知功能,在患者尚未发生痴呆之前,血浆SS含量就已下降,推测LA患者认知功能障碍可能与体内SS下降有关。