血管性认知障碍不同亚型患者认知功能及MRI检查的对比研究

目的探讨血管性认知障碍各亚型患者之间及其与认知功能正常者之间的认知功能及脑组织影像学表现的差异。方法采用简易智能状态检查量表、认知能力筛查量表和简易智能-认知能力联合检查量表对62例血管性认知障碍患者(无痴呆型血管性认知障碍34例、血管性痴呆18例、混合性痴呆10例)和50例正常对照者的认知功能进行评价,通过磁共振成像分析其容积测量值、脑叶萎缩、皮质下白质疏松和腔隙性脑梗死等影像学参数的差异。结果与对照组比较,血管性认知障碍各亚组患者认知功能评分呈逐步递减趋势(均P<0.05),但血管性痴呆与混合性痴呆患者之间差异无统计学意义(P>0.05)。血管性认知障碍各亚组患者双侧前额角容积、第三脑室容积测量值以及额叶、颞叶、顶叶、枕叶萎缩,皮质下白质疏松和腔隙性脑梗死评分均高于对照组(P<0.05),其影像学异常改变在进展为痴呆后更为明显。混合性痴呆患者的特征性表现为双侧海马容积、内嗅叶皮质容积减小,颞叶萎缩(均P<0.05),但无明显的腔隙性脑梗死(P>0.05)。结论血管性认知障碍患者的影像学异常改变可部分反映不同亚型的病理改变,但对认知障碍程度的反映尚缺乏敏感性,能否联合认知功能评分共同作为血管性认知障碍临床预测指标尚待进一步研究。

Vascular cognitive impairment subtypes:a comparative study with cognitive function and MRI

Objective To explore the discrepancy between vascular cognitive impairment(VCI) sub-types' patients and cognitive normal(CN) individuals based on cognitive function and brain structural imaging.Methods A case control study was performed.Different VCI subtypes' patients(n = 62) including 34 VCI no dementia(VCI-ND),18 vascular dementia(VD) and 10 mixed dementia(MD) were recruited,as well as 50 CN controls in matching with sex,age and education.Evaluated the cognitive function by Mini-Mental State Ex-amination(MMSE),Cognitive Capacity Screening Examination(CCSE) and Combined Mini-Mental-Cognitive Capacity Examinations(CMC),and investigated the brain structural magnetic resonance imaging(MRI) param-eters including volumetric changes of focus area,lobar atrophy,white matter leukoaraiosis and lacunar infarc-tion by computer-assisted graphical recognition and processing.Results In comparison with CN controls,the cognitive function assessment of various VCI subtypes' patients presented progressive decline(P < 0.05,for all),but the difference between VD and MD was not significant(P > 0.05).In MRI,the comparison between CN controls and various VCI subtypes' patients manifested on the following traits:1) enlargement of bilateral frontal horn volume and third ventricle volume(P < 0.05,for all);2) an increasing grade of frontal cortical atro-phy,temporal cortical atrophy,parietal cortical atrophy and occipital cortical atrophy(P < 0.05,for all);3) higher grades on white matter leukoaraiosis and lacunar infarction(P < 0.05,for all).Moreover,the brain struc-tural imaging variations amplified in advanced cognitive impairment.MD patients,however,without signifi-cantly increase in grade of lacunar infarction(P > 0.05),were characterized by decline of bilateral hippocampal volume and entorhinal cortical volume,as well as atrophy of temporal lobe(P < 0.05,for all).Conclusion The changes of brain MRI can partially reflect the pathological changes of different VCI subtypes' patients,but are not sensitive to the degree of cognitive impairment.More study should be performed to investigatewhether the combination of brain MRI and cognitive function assessment can be clinically used to predict VCI.