脑白质疏松症患者认知功能障碍的特征分析

目的 探讨脑白质疏松症患者认知功能障碍的特征.方法 研究对象来源于2010年9月至2011年3月就诊于首都医科大学附属北京朝阳医院神经内科门诊的46例脑白质疏松症患者和38名年龄、性别、受教育程度相匹配的健康老年人(对照组),采用美国国立神经疾病和卒中研究所-加拿大卒中网血管性认知障碍统一标准推荐的神经心理学评估方法,运用Fazekas量表评价脑白质病变的严重程度,将脑白质疏松症患者分为3组(轻度、中度和重度),比较不同程度的脑白质病变对认知功能的影响.结果 脑白质疏松症患者在总体认知功能评分( MMSE、MoCA)上显著低于对照组(24.4±3.2比28.3±1.2,20.4±3.0比26.2±0.8)(P＜0.05).此外,还在数字广度顺背(5.7±0.9比6.8±1.0)、数字广度倒背(3.5±0.7比4.1±0.7)、Stroop测验B(69±13比43±5)、Stroop测验C(141 ±42比65±10)、连线测验A型(73±15比31±7)、连线测验B型(126±18比82±6)、数字符号测验(25±6比37±5)等测验上成绩差于对照组(P＜0.05),而在言语流畅性(12.7±2.5比13.4±2.5)上差异无统计学意义(P＞0.05).脑白质疏松症患者的Fazekas评分与MoCA成绩呈负相关(r=-0.601,P=0.002).结论 脑白质疏松症患者存在明显的认知功能损害,主要表现为注意和记忆、执行功能、信息加工速度功能受损,这可能与脑白质病变导致的前额叶-皮质下环路功能障碍有关.

Characteristics of cognitive impairment in patients with leukoaraiosis

Objective To explore the characteristics of cognitive impairment in patients with leukoaraiosis (LA).Methods Forty-six LA patients and 38 age and gender-matched healthy subjects were recruited from the Department of Neurology,Beijing Chaoyang Hospital,Capital Medical University between September 2010 and March 2011.All participants underwent the neuropsychological tests recommended by the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards (NINDS/CSN).The were divided into 3 different groups (mild,moderate and severe) according to the Fazekas scale.The differences of neuropsychological performances were compared among 3 groups.Results The LA patients were associated with comprehensive cognitive function deficits,including MMSE (24.4 ± 3.2 vs 28.3 ± 1.2),MoCA ( 20.4 ± 3.0 vs 26.2 ± 0.8 ),digital span forward (5.7 ± 0.9 vs 6.8 ± 1.0),digital span backward ( 3.5 ± 0.7 vs 4.1 ± 0.7),Stroop-B (69 ±13 vs43 ±5),Stroop-C (141 ±42 vs 65 ± 10),trail making test-A (73 ± 15 vs 31 ±7),trail making test-B ( 126 ± 18 vs 82 ± 6) and digit symbol test ( 25 ± 6 vs 37 ± 5,P ＜ 0.05 ).However,there was no difference in the performance of verbal fluency ( 12.7 ± 2.5 vs 13.4 ± 2.5,P ＞ 0.05 ).Correlation analysis showed that the severity of LA had a negative correlation with the performance of MoCA ( r =-0.601,P =0.002).Conclusions The LA patients are closely correlated with cognitive impairments of attention,memory,executive function and information processing speed.It may be attributed to the frontalsubcortical circuitry dysfunction.