皮质下缺血性脑血管病认知功能障碍研究

目的应用系列神经心理学测试分析皮质下缺血性脑血管病(SIVD)患者的认知损害特征。方法入选SIVD患者53例,年龄及性别相当的健康老年人25例为正常对照组。SIVD患者按照认知损害的诊断标准分为血管性痴呆(VaD)组27例和血管性认知障碍非痴呆(VCIND)组26例。进行MMSE及血管性痴呆包括记忆力、注意力、语言、视空间结构及执行功能5个认知域在内的神经心理学测试,确定VCIND患者受损的认知域。结果①与正常对照组比较,VaD组患者各项量表测试均严重受损,具有统计学差异(P﹤0.05);②VCIND组患者MMSE、数字倒背评分下降,连线测验时间延长,差异有统计学意义(P﹤0.05);③VaD组与VCIND组相比,上述各项均受损严重,其中单词回忆、连线测验、画钟测验、数字广度测验评分差异有统计学意义(P﹤0.05)。结论①SIVD患者同时存在多个认知域损害,以执行功能、注意力损害较为突出,记忆、语言受累相对较轻;②VCIND患者表现为执行功能、注意力受损,程度均低于VaD组,晚期VaD患者全面认知功能明显下降。

Study of cognitive impairment in patients with subcortical ischemic vascular disease

Objective To analyze the cognitive profile of patients with subcortical vascular cognitive impairment by using a set of cognitive measures.Methods Extensive neuropsychological tests including MMSE and covering 5 cognitive domains were performed on 53 patients with SIVD diagnosed according to the MRI criteria of Erkinjuntti and 25 normal elderly controls(NC) matched in age and gender.The patients were divided into VaD(n=27)and VCIND group(n=26).Results ① The overall level of cognitive performance in these tests was significant inferior in VaD subjects as compared to NC subjects(P<0.05).②The patients with VCIND were worse than the normal elders in the tests including MMSE,digit span test(DST) backwards and trail making test(TMT)(P<0.05).③Between VaD and VCIND patients,significant differences were found in many fields.Compared with VCIND patients,VaD subjects showed decline on the word recall,TMT,clock drawing test and DST(P<0.05).Conclusion ① SIVD is related to comprehensive cognitive impairment,specifically contributed to the deterioration of executive and attention function.The impairments of language and memory are affected slightly.② The predominant impairments in patients with VCIND are executive and attention deficits,while in patients with VaD suffered from the progressive cognitive impairment and overall cognitive decline.