脑白质病变合并静止性腔隙性脑梗死患者认知功能的变化

目的 探讨脑小血管病变（small vessel disease，SVD）患者认知功能障碍的特点。方法 临床收集136例患者和22名正常对照人群，根据MRI T2加权像和FLAIR像将病例组分为单纯（white matter le-sions，WML）组、单纯（silent lacunar infarction，SLI）组和WML合并SLI组，分别进行简明精神状态量表（mini-mental state examination，MMSE）、积木测验和画钟测验。结果 （1）单纯SLI组和WML合并SLI组患者的MMSE和积木测验评分均明显低于对照组（P〈0.01），单纯WML组、单纯SLI组和WML合并SLI组患者的画钟测验评分明显低于对照组；（2）与对照组比较，单纯WML组患者MMSE各项评分无明显下降；单纯SLI组患者注意计算、短程记忆、图形描画评分显著降低；WML合并SLI组患者时间定向、注意计算、短程记忆、语言理解和图形描画评分显著降低。结论 （1）脑小血管病变，尤其是WML合并SLI时，可导致认知功能下降；（2）WML合并SLI组患者主要表现为执行功能、视空间功能、注意计算、短程记忆等认知方面的障碍。     

脑皮质下小血管病变与脑萎缩的相关性分析

目的探讨脑皮质下小血管病变与脑萎缩的相关性。方法通过10例临床确诊为脑萎缩的病人的调查,收集其临床基本资料及头颅磁共振成像(magnetic resonance imaging,MRI)的结果及图像,评判其脑皮质下小血管的病变情况。结果所有病例颅脑MRI均发现显著的弥漫性脑白质病变(white matter lesions,WML)和多发的脑腔隙性梗死灶(lacunarinfarcts,LI)。结论颅脑MRI提示,脑皮质下小血管病变与脑萎缩共存,提供了其与脑萎缩可能有关的临床依据。     

脑小血管闭塞患者认知功能变化的临床研究

目的探讨脑小血管闭塞(SAO)患者认知功能变化情况,比较SAO患者和正常者认知功能障碍发生率。方法选择120例SAO患者为观察组,根据SAO分型分为单纯性腔隙性梗死组(ILI组)和缺血性白质疏松组(ILA组)各60例。选择神经功能正常者50例为对照组。所有受试者均接受mmSE和MoCA量表测试,比较2组mmSE评分和MoCA评分,并根据评分结果统计认知障碍发生率。结果ILA组mmSE评分和MoCA评分分别为(23.17±2.93)分、(20.13±3.75)分,均显著低于ILI组和对照组(P0.05)。ILI组mmSE评分和MoCA评分分别为(26.15±2.85)分和(23.75±3.86)分,均显著低于对照组(P0.05)。根据mmSE评分和MoCA评分,ILA组和ILI组认知障碍率均显著高于对照组(P0.05)。ILA组和ILI组认知障碍发生率差异无统计学意义(P0.05)。结论较之正常人群,SAO患者存在一定的认知障碍,认知障碍发生率更高。SAO患者认知功能障碍与病情发展有一定关系,较之ILI患者,ILA患者认知功能障碍更为严重。     

脑小血管闭塞患者认知功能变化的研究

目的探讨脑小血管闭塞患者认知功能的变化,分析其临床意义。方法选取2011-03—2013-04我院脑神经内科接诊的脑小血管发病患者86例为观察组,另选取同期我院健康体检者68例为正常组。分别采用蒙特利尔认知评估表(MOCA)以及简易精神状态检查(MMSE)评估2组认知功能。结果观察组与正常组的蒙特利尔认知评估表(MOCA)评分为(17.68±6.22)分、(27.35±1.35)分,差异有统计学意义(P0.05);简易精神状态评分(MMSE)分别为(29.68±1.32)分与(29.35±1.25)分,差异无统计学意义(P0.05)。观察组视觉空间与执行能力、延迟回忆、注意力等方面的分值低于正常组,而命名、语言、抽象、定向评分方面2组差异无统计学意义(P0.05)。结论脑小血管闭塞患者存在认知功能障碍,蒙特利尔认知评估表(MOCA)以及简易精神状态检查(MMSE)能有效反映其认知功能的变化,有利于对其早期认知功能障碍进行诊断和筛查。     

不同程度脑白质病变对腔隙性梗死患者认知功能的影响

目的分析腔隙性梗死(LI)脑白质病变(WML)程度与认知功能的相关性。方法以30例LI无WML者为对照组,30例LI合并轻度WML者为轻度组,30例LI合并中度WML者为中度组,30例LI合并WML者为重度组,分析4组认知功能及WML程度与认知功能的相关性。结果 4组间各项MMSE评分、MMSE总评分、各项MoCA评分及MoCA总评分比较,差异有统计学意义(P0.05),均以重度组最低,对照组最高。同时,WML程度与MMSE总评分及MoCA总评分存在负向直线相关性(P0.05)。结论 LI患者WML程度与认知功能存在显著的相关性,可用于评估患者认知功能。     

急性腔隙性脑梗死伴脑白质病变对认知功能的变化影响

目的探讨急性腔隙性脑梗死（LI）伴脑白质病变（WML）患者的认知功能障碍特点。方法收集137例患者和正常对照组30例,根据头颅MRIT2加权像及FLAIR像,将病例组分为LI组、WML组和u合并WML组,应用蒙特利尔认知评估量表（MoCA）进行认知评估。结果与对照组相比,WML组的延迟回忆与语言评分明显下降（P〈0．01）;LI组患者注意计算、语言、执行功能评分显著降低（P〈0．01）;LI合并WML组患者延迟记忆、视空间与执行功能评分显著降低（P〈0．01）。与LI组和WML组相比,执行功能障碍在LI合并WML组更明显（P〈0．01）。结论LI合并WML可导致患者认知功能障碍,主要表现为延迟记忆、视空间与执行等认知功能的受损;MoCA在皮层下缺血性脑血管病引起的血管性认知障碍的评定中具有很大的优势。     

不同麻醉方案对腔隙性梗死患者术后发生认知功能障碍的影响比较

目的探究硬膜外麻醉和全身复合麻醉对腔隙性梗死患者术后认知功能的影响,探讨该类患者认知功能受损的影响因素。方法选取2010-06—2013-06我院收治的74例腔隙性梗死需急诊手术的患者,随机分为硬膜外麻醉组和全身复合麻醉组,通过比较术前与术后神经功能来评价硬膜外麻醉和全身复合麻醉对腔隙性梗死患者麻醉后认知功能的影响。结果 2组患者术后认知功能比术前评分有显著降低(P0.05),相对于复合全身麻醉组,硬膜外麻醉组术后6h、24h及72h的认知功能障碍(postoperative cognitive dysfunction,POCD)发生率较低,简易智能状态检测评分(MMSE)以及蒙特利尔认知评估表评分(MoCA)结果较好。结论硬膜外麻醉和全身复合麻醉均对腔隙性梗死患者的认知功能存在一定的影响;但两种麻醉方式比较,硬膜外麻醉比全身复合麻醉影响更小,可作为腔隙性梗死患者手术的首选麻醉方式。     

脑微出血与认知功能障碍的相关危险因素分析

目的分析脑微出血患者与认知功能障碍的相关危险因素。方法选取我院收治的确诊为短暂性脑缺血发作、腔隙性梗死患者共280例为研究对象,按照蒙特利尔认知评估表(MoCA)评分将患者分成2组,其中≥26分248例为正常组,26分32例为异常组。研究分析脑微出血与认知功能障碍的相关危险因素。结果 280例患者中70例患者出现脑微出血(CMB)阳性,阳性率25%,单因素分析显示,2组CMB阳性例数、CMB数量、接受教育时间、脑白质疏松例数差异均有统计学意义(P0.05),通过Logistic回归分析对患者的影响因素进行分析,结果显示CMB阳性例数、CMB数量、接受教育的时间的OR值分别是4.57,1.44,0.71(P0.05)。结论脑微出血阳性以及脑微出血的数量是认知功能降低的危险因素,可与其他脑血管疾病危险因素同时存在。     

脑小血管病的血管病理学改变及其结局

脑小血管病是临床和基础研究的热点之一,近年从临床流行病学、解剖学、病理学、分子遗传学、神经影像学和分子医学等方面,对脑小血管病进行了深入的探索,建立了许多理论,形成了诸多概念。这些多学科的理论和概念逐渐相互融合、相互补充,也导致了理解上一定程度的混乱。本专题试图阐述脑小血管的解剖学基础、     

血浆同型半胱氨酸与腔隙性脑梗死及认知功能关系

目的:探讨血浆同型半胱氨酸(Hcy)与腔隙性脑梗死的关系以及对认知功能的影响。方法:选取112例腔隙性脑梗死患者及50名健康对照者,检测血浆Hcy水平以及简易智能精神状态检查表(MMSE)评分。结果:①Hcy水平腔隙性脑梗死组明显高于对照组(P<0.05);②Logistic回归证实Hcy水平升高是腔隙性脑梗死的独立危险因素,OR为1.212;③Hcy水平与MMSE分值呈负相关(r=-0.552,P<0.001);④多元线性回归分析得出腔隙性脑梗死患者MMSE分数=45.771-7.314×logHcy-0.171×年龄。结论:血浆Hcy水平升高是腔隙性脑梗死的独立危险因素,对认知功能有独立的影响。     

Effects of middle cerebral artery occlusion on spontaneous activity and cognitive function in rats

The middle cerebral artery occlusion (MCAO) in the rat is a commonly used model to evaluate new therapeutic strategies for the treatment of ischemic stroke. However, many such studies rely on short-term neurological examination and infarct volume as endpoint measures while neglecting more long-term functional assessments. In this study, we examined whether there were changes in passive avoidance behavior, spontaneous behavioral patterns across the light-dark cycle, and motor coordination as measured on the rotorod test 1 month after Sprague-Dawley rats had undergone MCAO. Compared to age-matched controls, fewer animals in the MCAO group remained on the platform during the passive avoidance retention test (p < .03). Significant differences between the groups were observed in the spontaneous activity during the initial portions of both the light and dark testing periods, when the test situation was new (p < .01 to .05, depending on the variable examined). Any differences on the rotorod test failed to gain statistical significance. These results suggest that at least the passive avoidance test and measures of spontaneous activity are sensitive to ischemia-induced damage over a more prolonged survival period and therefore may be appropriate measures for long-term effectiveness of new treatments.     

Cerebral small vessel disease and post-stroke cognitive impairment

Cerebral small vessel disease (CSVD) refers to a group of pathological processes with multifarious etiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. Features seen on neuroimaging include white matter hyperintensities, lacunar infarction, cerebral microbleeds, brain atrophy, microinfarcts and enlarged perivascular spaces (EPVS). CSVD gives rise to one in five strokes worldwide and is a leading cause of cognitive impairment and dementia, especially in the elderly. Post-stroke cognitive impairment (PSCI) is one of the most common subtypes of cognitive impairment. The underlying mechanisms of PSCI are not known in detail. A growing body of evidence has been suggesting that CSVD plays an important role in the pathogenesis of PSCI. This article reviews the advances in research on the relationship between CSVD and PSCI.     

Cerebral ventricular changes associated with transitions between normal cognitive function, mild cognitive impairment, and dementia

Expansion of the cerebral ventricles may occur at an accelerated rate in subjects with dementia, but the time course of expansion during transitions between normal cognitive function, mild cognitive impairment (MCI), and dementia is not well understood. Furthermore, the effects of cardiovascular risk factors on rate of ventricular expansion are unclear. We used a fully automated segmentation technique to measure change rate in lateral ventricle-to-brain ratio (VBR) on 145 longitudinal pairs of magnetic resonance images of subjects in the Cardiovascular Health Study Cognition Study from the Pittsburgh Center. A multivariate model analyzed VBR change rate, accounting for dementia statuses at both imaging times (normal, MCI, or dementia), age, sex, education, race, magnetic resonance-defined infarcts, Center for Epidemiology Studies Depression Scale, baseline ventricular volume, and cardiovascular risk factors. VBR change was faster in subjects who were demented or transitioned from MCI to dementia, compared with subjects normal at both images and subjects who transitioned from normal to MCI or dementia. Patients with diabetes had faster VBR change. Ventricular expansion may accelerate late in the progression from normal cognitive function to dementia, and may be modulated by diabetes.     

Cerebral blood flow, glucose utilization, and electrocorticograms following common carotid artery occlusion in gerbils

We designed this study to elucidate the relations between cerebral function and glucose metabolism during the early stage of ischemia. We induced focal cerebral ischemia in 28 gerbils by occluding the common carotid artery. We recorded electrocorticograms in 34 gerbils by positioning bipolar electrodes between the anterior and middle cerebral arteries. We related the electrocorticograms to local cerebral glucose utilization measured with [14C]2-deoxyglucose in half the gerbils. A characteristic pattern (a zone of markedly decreased [14C]2-deoxyglucose uptake surrounded by a narrow band of greatly increased uptake) was observed on the autoradiogram in nine of the 14 experimental gerbils (64%). An electrocorticogram recorded from such a band of increased uptake was characterized by transient suppression of electrical activity followed by partial or complete recovery, and local cerebral blood flow in gerbils showing this electrocorticographic type were variable (15.0-43.3 ml/100 g/min). An electrocorticogram recorded from the ischemic core and inner border of this band, even when [14C]2-deoxyglucose uptake was relatively high, was characterized by the complete disappearance of electrical activity just after occlusion; cerebral blood flow in gerbils that showed this electrocorticographic type were consistently less than 15.0 ml/100 g/min. Our investigation suggests that the transient disappearance of electrocorticographic activity in the periphery of ischemia, which has relatively high residual blood flow, may relate to the heterogeneity of glucose consumption during the early stage of ischemia.     

Cerebral cortical microinfarcts in patients with internal carotid artery occlusion

Cerebral cortical microinfarcts (CMI) are small ischemic lesions that are associated with cognitive impairment and probably have multiple etiologies. Cerebral hypoperfusion has been proposed as a causal factor. We studied CMI in patients with internal carotid artery (ICA) occlusion, as a model for cerebral hemodynamic compromise. We included 95 patients with a complete ICA occlusion (age 66.2 ± 8.3, 22% female) and 125 reference participants (age 65.5 ± 7.4, 47% female). Participants underwent clinical, neuropsychological, and 3 T brain MRI assessment. CMI were more common in patients with an ICA occlusion (54%, median 2, range 1–33) than in the reference group (6%, median 0; range 1–7; OR 14.3; 95% CI 6.2–33.1; p<.001). CMI were more common ipsilateral to the occlusion than in the contralateral hemisphere (median 2 and 0 respectively; p<.001). In patients with CMI compared to patients without CMI, the number of additional occluded or stenosed cervical arteries was higher (p=.038), and cerebral blood flow was lower (B −6.2 ml/min/100 ml; 95% CI −12.0:–0.41; p=.036). In conclusion, CMI are common in patients with an ICA occlusion, particularly in the hemisphere of the occluded ICA. CMI burden was related to the severity of cervical arterial compromise, supporting a role of hemodynamics in CMI etiology.     

Cerebral atrophy as predictor of cognitive function in old, community-dwelling individuals

Objectives – The impact of cortical and subcortical atrophy on cognitive function was examined in a sample of older community-dwelling men and women.
Material and methods – Magnetic resonance imaging was performed on a sample of 129 individuals [age: 68.4 ± 3.6 years (mean ± SD), range 64–74 years, 64 women and 65 men, Mini-Mental State Examination scores above 23] to assess cortical and subcortical atrophy. Participants also performed a number of cognitive tasks, and the measures of atrophy were used to predict performance in these tasks.
Results – In men, frontal cortical atrophy predicted worse performance in word fluency and the Stroop test, and occipital cortical atrophy was associated with poor performance in motor speed. In women, poor performance in motor speed was associated with subcortical atrophy at the level of the caudate nucleus.
Conclusion – Atrophy in certain areas was associated with poor performance in specific cognitive tasks, although the amount of explained variance was rather limited in this quite homogenous sample.     

Sensorimotor and cognitive consequences of middle cerebral artery occlusion in rats.

Rats were subjected to either right proximal middle cerebral artery (MCA) occlusion or sham operation, and examined for an extended period on a battery of tests designed to measure simple motor function, sensorimotor integration and cognitive function. Rats with MCA occlusion showed extensive neuronal loss in the dorsolateral striatum and variable neuron loss in the parietal, temporal and frontolateral neocortex. MCA occluded animals exhibited significant impairments in tests of postural reflex, visual and tactile forelimb placing, locomotor coordination, and a test of simultaneous bilateral tactile extinction. The reflex and sensorimotor function deficits recovered to pre-operative levels by Day 30 post-ischemia. Five weeks following surgery, rats were tested in 2 versions of the Morris water task. Rats with MCA occlusion demonstrated significant impairments in their ability to navigate to a hidden platform, but were not significantly impaired on the visible (cued) version of the task. This general pattern of transient sensorimotor and reflex deficits, but with more persistent cognitive impairments, is similar to that seen in humans following MCA infarcts.     

冠状动脉旁路移植术与认知功能变化

冠状动脉旁路移植术（coronary＇ artery bypass grafting,CABG）早期术式是从患者身上取不影响生理功能的静脉或动脉,一端连接于升主动脉,另一端连接于冠状动脉病变的远端,血流即可绕过狭窄的冠状动脉给心脏供血,像一座“桥”到达远端的心肌,故亦称为“冠脉搭桥术”。