脑白质疏松对脑血管事件和认知功能的影响

目的 评估脑白质疏松（leukoaraiosis，LA）的危险因素，以及对老年患者后期脑血管事件和认知功能障碍发病率的影响。 方法 连续入组北京安贞医院神经内科253例门诊患者，分为LA组和对照组，按照LA的严重程度，LA组分为轻度组、中度组、重度组。将简明精神状态量表（Mini-Mental State Examination，MMSE）和蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）（北京版）作为认知评估工具。分析各组患者一般临床资料和认知功能，随访观察并比较各组患者脑梗死、脑出血以及认知功能障碍的发病率。 结果 LA组与对照组相比，患有高血压、糖尿病的比例显著升高，差异有显著性（P值分别为0.003和0.004）。中、重度LA组与对照组相比，认知障碍的患病率显著升高（P值分别为0.035和0.019）。随访1年，轻、中、重度LA组脑梗死的发病率均高于对照组，差异有显著性（P值分别为0.019、0.024和0.049）。四组间脑出血的发病率无显著差异。轻、中、重度LA组的新发认知障碍的发病率高于对照组，差异有显著性（P值分别为0.048、0.036和0.004）。 结论 老年LA患者认知障碍的患病率高于无白质疏松人群，且1年内新发认知障碍和缺血性卒中的发病率也高于无白质疏松人群。

Effects of Leukoaraiosis on Subsequent Cerebral Vascular Disease and Cognitive Function

Objective To determine whether the presence of leukoaraiosis （LA） is a risk factor for subsequent cerebral vascular disease and cognitive impairment. Methods We prospectively examined 253 consecutive outpatients at Department of Neurology of Beijing Anzhen Hospital. The patients were divided into two groups：patients with leukoaraiosis （LA group） and patients without leukoaraiosis （control group）. According to the scores, the patients in LA group were divided into mild, moderate and severe groups. Mini Mental State Examination （MMSE） and Montreal Cognitive Assessment （MoCA） （Beijing version） were used to assess the cognitive function. We analyzed clinical data. Patients were then followed up for the development of stroke and cognitive changes. Results In LA group, hypertension and diabetes were more common and there was signiifcant difference between LA and control group （P=0.003 and P=0.004, respectively）. The prevalence of cognitive impairment in moderate and severe LA groups was much higher than those in control group （P=0.035 and P=0.019, respectively）. The incidences of cerebral infarction in mild, moderate and severe LA group were much higher than those in control group （P=0.019, P=0.024 and P=0.049, respectively）. The incidences of cognitive impairment in mild, moderate and severe were much higher than those in control group （P=0.048, P=0.036 and P=0.004, respectively）. There was signiifcant difference between LA and control group for the development of cerebral infarction and cognitive impairment. Conclusion The incidence of cerebral infarction and cognitive impairment rose in senile patients with leukoaraiosis.