脑白质病变相关性轻度认知功能障碍患者神经心理学特征分析

目的观察脑白质病变(WML)对轻度认知功能损害(mild cognitive impairment,MCI)患者神经心理学的影响。方法 WML-MCI患者和健康对照者进行常规核磁共振及神经心理学检查,观察WML对MCI患者神经心理学的影响,并对其机制进行探讨。结果 WML-MCI组与对照组相比,高血压、糖尿病和冠心病比例明显增高;词语流畅性测验、积木测验和画钟测验评分均明显降低(P<0.05);而2组间MMSE、数字广度测验和词语延迟回忆测验评分无明显差异。结论 WML影响MCI患者的认知功能,主要表现为视空间及执行功能。血管危险因素是MCI发病的危险因素。     

缺血性脑白质病变与认知功能障碍的相关性研究

目的探缺血性脑白质病变与认知障碍的关系,为血管性痴呆的预防、早期诊断和治疗提供理论依据。方法选择138例经颅脑MRI证实的脑白质病变患者,并分为缺血性脑白质病变组和非缺血性脑白质病变组,分别进行简易智能状态检查量表（MMSE）评估比较,并对白质病变进行分级,进行组内及两组患者认知功能严重程度比较。结果缺血性白质病变组认知功能障碍发生率及Ⅱ、Ⅲ段白质病变者的认识功能障碍的严重程度明显高于非缺血性白质病变组;组内比较缺血性白质病变组和非缺血性白质病变组认知功能障碍与白质病变严重分级呈正相关,而二者无明显关系。结论缺血性白质病及其严重程度对认知功能障碍的发生及严重程度有显著影响,而非缺血性白质病则对认知功能障碍影响较小。     

卒中后轻度认知功能障碍与脑白质病变的研究

脑白质病变,在影像学中又称为脑白质疏松症,是脑微血管病变的一种重要类型。有大量研究表明,卒中后轻度认知功能障碍与脑白质病变存在明显的相关性。弥散张量成像对白质纤维的显示具有一定的优势,成为卒中后认知功能障碍研究的重要工具。本文对近年来卒中后认知功能障碍与脑白质病变的相关研究予以综述。     

不同类型脑白质疏松症患者轻度认知功能障碍认知域损害特点分析

目的探讨不同类型脑白质疏松症(LA)患者轻度认知功能障碍(MCI)认知域损害特点。方法LA患者256例,根据MCI诊断标准筛选出MCI患者181例,按入院时头颅磁共振成像(MRI)的脑白质疏松部位分为三组:脑室周围型(第一组)72例、皮质下型(第二组)56例、混合型(第三组)53例。分析比较三组认知域损害类型、Mo CA量表检测比较认知损害内容。结果 1LA患者MCI检出情况:256例LA患者进入MCI筛查,有181例诊断为MCI(70.70%);其中脑室周围型LA 72例(39.78%),皮质下型56例(30.94%),混合型53例(29.28%),三组比较差异无统计学意义;2三组MCI认知域损害类型比较:第一组以遗忘型单认知域损害MCI(a MCI-s)型、遗忘型多认知域损害MCI(a MCI-m)型为主(51.40%、25.00%);与非遗忘型单认知域损害MCI(na MCI-s)型(13.88%)、非遗忘型多认知域损害MCI(na MCI-m)型(9.72%)比较差异有统计学意义(p<0.01);且a MCI-s与a MCI-m比较,p<0.01。第二组以a MCI-m及a MCI-s较多见(42.86%、30.35%),与na MCI-s(8.93%)、na MCI-m(17.86%)比较,p<0.01;且a MCI-m与a MCI-s比较,p<0.05;第三组以a MCI-m及a MCI-s较多见(52.83%、26.41%),与na MCI-s(7.55%)、na MCI-m(13.21%)比较,p<0.01;且a MCI-m与a MCI-s比较,p<0.05;3三组Mo CA量表检测认知损害内容比较:三组在延迟记忆项得分最低:1.39±1.42、1.44±1.06、1.51±1.32,但组间比较差异无统计学意义;第二、三组Mo CA总分分别为20.43±3.01、20.66±3.14,较第一组21.52±2.68明显降低(p<0.05);其中抽象功能项第二、三组分别为0.58±0.56、0.59±0.51,较第一组(0.78±0.67)降低最显著(p<0.01);视空间与执行功能项第二、三组分别为2.92±0.92、3.04±1.03,较第一组(3.71±0.75)亦有降低(p<0.05);第二、三组认知损害内容比较,P>0.05。结论三种类型LA与MCI存在相似的相关性,提示对于任何一种LA均需严密筛查、预防MCI的发生、发展;不同类型LA所致MCI的认知损害类型各有特点:脑室周围型以a MCI-s最多,记忆障碍为其主要表现,皮质下型、混合型LA更多表现为a MCI-m,即包括记忆障碍在内的多个认知功能损害;在MCI认知损害内容方面,延迟记忆障碍是各型LA相关性MCI最显著的共同特点;皮质下型、混合型LA对认知功能的影响更显著,尤其在抽象功能方面,视空间与执行功能也存在一定影响。认识这样的差异有助于早期识别LA相关MCI、有针对性地选择干预方式,以规范LA的二级预防。     

小血管病性脑白质病变与认知功能障碍关系研究

目的 评估小血管病患者脑白质病变程度与认知功能的相关性。 方法 通过对浙江大学医学院附属第一医院神经内科门诊患者进行老年人认知功能下降知情者问 卷（informant questionnaire on cognitive decline in the elderly,IQCODE）、简易智能状态检查量表（minimental state examination,MMSE）、临床痴呆评定量表（clinical dementia rating,CDR）评分以及相关认 知功能评估,结合头颅磁共振成像（magnatic resonance imaging,MRI）检查及临床资料,筛选小血管病 变患者,并通过相关统计分析计算不同部位脑白质病变的程度及其对认知功能的影响。 结果 本研究共纳入患者147例,其中小血管病变（cerebral small vessel disease,SVD）患者33例,SVD患 者记忆力（z =-3.36）、定向力（z＝-3.14）、处理判断力（z =-3.38）以及社会事物能力（z =-3.22）较 正常者都明显下降（P =0.00）。脑室周围病变与MMSE分数（r =0.82）、CDR总分（r =0.62）、CDR记忆分 （r =0.82）显著相关（P值均=0.00）,皮质下病变与MMSE分数（r =0.51,P =0.01）、CDR记忆分（r =0.49, P =0.02）中度相关。 结论 在脑小血管病患者,MMSE评分、CDR评分对于脑白质病变特别是脑室旁病变的进展可能具有 一定的预测价值。     

轻度认知功能障碍与脑白质弥散张量成像的相关性研究

目的通过磁共振弥散张量成像研究不同区域脑白质损害与轻度认知功能(MCI)的关系。方法纳入2015年7月至2016年2月我院的住院患者56例为研究对象,其中MCI组34例,认知功能正常组22例。所有研究对象进行一般情况检查,完成神经心理学量表检测。通过头颅磁共振弥散张量成像(DTI)检查对不同脑区白质纤维进行部分各向异性(FA)值测量。结果 MCI组患者与认知功能正常组相比,右侧额叶FA值(0.335±0.068)、左侧颞叶白质FA值(0.391±0.032)及胼胝体膝部FA值(0.658±0.053)降低,差异具有统计学意义(P0.05)。将上述FA值和MMSE、Mo CA量表中各认知域进行典型相关分析,结果显示右侧额叶白质FA值与注意与计算力呈正相关,左侧颞叶白质和胼胝体膝部FA值与记忆力呈正相关(P0.05)。结论 MCI患者注意与计算力的障碍可能与右侧额叶白质损害有关,而左侧颞叶白质及胼胝体膝部白质的损害可能导致早期的记忆障碍。DTI可能成为超早期识别与诊断MCI的新方法。     

糖尿病患者血糖波动与轻度认知功能障碍的关系

目的 探讨糖尿病患者血糖波动与轻度认知功能障碍的关系。方法 选择本院2015年1月-2017年8月收治的81例2型糖尿病患者,按患者有无轻度认知功能障碍分为轻度认知功能障碍组(33例),48例非轻度认知功能障碍患者做为对照组; 对2组临床资料进行单因素及多因素分析,明确糖尿病患者轻度认知功能障碍的可能危险因素,分析日内平均血糖波动幅度(MAGE)、血糖水平标准差(SDBG)、平均餐后血糖波动幅度(MPPGE)、日间血糖波动幅度(MODD)和蒙特利尔认知评估量表(MoCA)相关性,采用受试者工作绘制特征(ROC)曲线分析MAGE、SDBG、MPPGE、MODD与轻度认知功能障碍的联系。结果 轻度认知功能障碍组和对照组在病程、舒张压、收缩压、尿酸、肌酐无明显差异(P>0.05)。轻度认知功能障碍组年龄、低密度脂蛋白(LDL-C)、FPG、2hPG、HbA1c、MAGE、SDBG、MPPGE、MODD水平均高于对照组,受教育年限低于对照组(P<0.05)。多因素Logistic回归分析显示FPG、2hPG、HbA1c、MAGE、SDBG、MPPGE、MODD水平为轻度认知功能障碍发生的独立危险因素。相关性分析可见糖尿病患者MAGE、SDBG、MPPGE、MODD水平和MoCA评分均呈负相关(r=-0.459,-0.376,-0.501,-0.618,P<0.05)。ROC曲线显示,MAGE曲线下面积为0.679、SDBG为0.525、MPPGE为0.811、MODD为0.795、联合检测曲线下面积为0.869(P<0.05)。结论 糖尿病患者轻度认知功能障碍为多因素所致,其中血糖波动和轻度认知功能障碍有着良好相关性,合理控制血糖可能有利于延缓或者预防轻度认知功能障碍。     

脑白质病变患者认知功能的前瞻性研究

目的 探讨不同部位和严重程度脑白质病变（white matter lesions,WMLs）患者的认知功能损害特点。 方法 前瞻性纳入179例WMLs病例和97例磁共振成像（magnetic resonance imaging,MRI）正常对照组, 并收集人口学资料,对WMLs的严重程度进行Fazekas视觉等级评分,依据WMLs病变部位分为皮质下脑 白质病变（subcortical white matter lesions,SWML）组、脑室旁脑白质病变（periventricular lesions,PVL）组 和混合组,采用蒙特利尔认知评估量表（Montreal Cognitive Assessment Scale,MoCA）分析不同部位和 严重程度WMLs的认知功能差异。根据MoCA将WMLs组分为WMLs认知损害亚组（116例）及WMLs认知正 常亚组（63例）,分析探讨WMLs患者认知损害的危险因素。 结果 与正常组比,WMLs组在MoCA总分（P ﹤0.001）、视空间与执行能力（P ﹤0.001）、命名（P =0.019）、 语言（P =0.005）、抽象理解（P =0.003）、延迟记忆（P ﹤0.001）方面显著性减低。Fazekas分级越高, MoCA总分及各项评分显著减低（P均﹤0.05）。PVL组、SWML组和混合组与对照组相比,在MoCA总分（P 均﹤0.001）、视空间与执行能力（P 均﹤0.001）、语言（P =0.006,0.022,0.008）、抽象理解（P =0.003, 0.011,0.016）及延迟记忆（P均﹤0.001）上差异有统计学意义。WMLs亚组分析显示高教育程度是WMLs发 生认知损害的保护因素。 结论 高教育程度是WMLs患者认知损害的保护因素。WMLs患者在视空间与执行功能、延迟回忆方面 存在明显的认知损害。WMLs病变程度越严重,认知功能下降越显著。皮质下WMLs、脑室旁WMLs及混 合组均在视空间与执行能力、语言、抽象理解、延迟记忆方面损害严重。     

老年脑白质病变认知功能下降影响因素研究

目的 探讨老年脑白质病变（white matter lesion,WML）患者认知功能下降的影响因素及预测因子。方法 连续登记2014年9月-2016年9月期间,郑州大学第一附属医院老年病科、神经内科门诊及住院的无认知功能障碍的WML患者,收集患者人口学资料、血管危险因素及磁共振成像检查结果。入组时行蒙特利尔认知评估量表（Montreal cognitive assessment scale,MoCA）及脑白质改变分级量表（age-related white matter changes rating scale,ARWMCRs）评定。根据1年随访时MoCA量表评分分为轻度认知功能障碍（mild cognitive impairment,MCI）组和无认知障碍组。通过单因素和多因素Logistic回归分析,判断老年WML患者认知功能下降的影响因素及预测因子。结果 研究共入组118例WML患者,其中男性67例,女性51例,平均年龄（68.07±3.70）岁。1年随访时有100例（84.75％）患者保持原有认知状态不变,18例（15.25％）进展为MCI。Logistic回归分析发现高血压病[比值比（odds ratio,OR）1.47,95%可信区间（confidence interval,CI）1.08～1.93,P =0.013）]和糖尿病（OR 1.38,95%CI 1.01～1.88,P =0.042）是WML患者进展为MCI的独立危险因素,ARWMCRs评分≥8分（OR 1.84,95%CI 1.38～2.47,P =0.004）是WML患者进展为MCI的独立预测因子。结论 高血压病和糖尿病是WML患者进展为MCI的独立危险因素,ARWMCRs评分≥8分是WML患者进展为MCI的独立预测因子。     

脑白质损害和轻度认知功能损害的关系

目的 研究脑白质损害(White matter lesions,WML)对轻度认知功能损害(Mild cognitive impairment,MCI)患者认知功能的影响.方法 80例MCI患者和80例健康对照者进行常规核磁共振(MRI)及认知功能检查,对WML进行评分及分级,分析WML与认知功能的联系及MCI发病的危险因素.结果 MCI组WML的评分、年龄及中度、重度WML、总WML的比率较对照组升高,其认知功能较对照组下降,且与WML评分相关.年龄、中度WML、重度WML与MCI发病有关.结论 WML影响MCI患者的认知功能,年龄、WML是MCI发病的危险因素.     

Differences in grey and white matter atrophy in amnestic mild cognitive impairment and mild Alzheimer's disease

Background:  Grey matter (GM) atrophy has been demonstrated in amnestic mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD), but the role of white matter (WM) atrophy has not been well characterized. Despite these findings, the validity of aMCI concept as prodromal AD has been questioned.
Methods:  We performed brain MRI with voxel-based morphometry analysis in 48 subjects, aiming to evaluate the patterns of GM and WM atrophy amongst mild AD, aMCI and age-matched normal controls.
Results:  Amnestic mild cognitive impairment GM atrophy was similarly distributed but less intense than that of mild AD group, mainly in thalami and parahippocampal gyri. There were no difference between aMCI and controls concerning WM atrophy. In the mild AD group, we found WM atrophy in periventricular areas, corpus callosum and WM adjacent to associative cortices.
Discussion:  We demonstrated that aMCI might be considered a valid concept to detect very early AD pathology, since we found a close proximity in the pattern of atrophy. Also, we showed the involvement of WM in mild AD, but not in aMCI, suggesting a combination of Wallerian degeneration and microvascular ischaemic disease as a plausible additional pathological mechanism for the discrimination between MCI and AD.     

Brain perfusion correlates of medial temporal lobe atrophy and white matter hyperintensities in mild cognitive impairment

Abstract Objective To assess the association of Medial Temporal lobe Atrophy (MTA) and White Matter Hyperintensities (WMHs) with gray matter perfusion in Mild Cognitive Impairment (MCI). Methods 56 MCI patients (age = 69.3 ± 7.0, 32 females) underwent brain MR scan and ^99mTc ECD SPECT. We evaluated MTA according to Scheltens' fivepoint scale on T1 MR images, and assessed WMHs using the rating scale for age-related white matter changes on T2-weighted and FLAIR MR images. We divided MCI into age-matched subgroups with high and low MTA and high and low WMHs load. We processed SPECT images with SPM2 following an optimized protocol and performed a voxel-based statistical analysis comparing high vs. low MTA and high vs. low WMHs, setting p-value at 0.001 uncorrected, thresholding cluster extent at 100 voxels, using proportional scaling and entering age and WMHs or MTA respectively as nuisance covariates. Results MCI with high compared with low MTA showed hypoperfusion in the left hippocampus and in the left parahippocampal gyrus. MCI with high compared with low WMHs showed a hypoperfusion area in the left insular region and superior temporal gyrus. Conclusions MTA in MCI is associated with hippocampal gray matter hypoperfusion while WMHs is associated with gray matter hypoperfusion in areas of the insula and temporal neocortex. These results confirm that MTA is associated with local functional changes and suggest that WMHs may be associated with remote brain cortical dysfunction.     

The effect of white matter signal abnormalities on default mode network connectivity in mild cognitive impairment

Regions within the default mode network (DMN) are particularly vulnerable to Alzheimer's disease pathology and mechanisms of DMN disruption in mild cognitive impairment (MCI) are still unclear. White matter lesions are presumed to be mechanistically linked to vascular dysfunction whereas cortical atrophy may be related to neurodegeneration. We examined associations between DMN seed‐based connectivity, white matter lesion load, and cortical atrophy in MCI and cognitively healthy controls. MCI showed decreased functional connectivity (FC) between the precuneus‐seed and bilateral lateral temporal cortex (LTC), medial prefrontal cortex (mPFC), posterior cingulate cortex, and inferior parietal lobe compared to those with controls. When controlling for white matter lesion volume, DMN connectivity differences between groups were diminished within bilateral LTC, although were significantly increased in the mPFC explained by significant regional associations between white matter lesion volume and DMN connectivity only in the MCI group. When controlling for cortical thickness, DMN FC was similarly decreased across both groups. These findings suggest that white matter lesions and cortical atrophy are differentially associated with alterations in FC patterns in MCI. Associations between white matter lesions and DMN connectivity in MCI further support at least a partial but important vascular contribution to age‐associated neural and cognitive impairment.     

Orientational changes of white matter fibers in Alzheimer's disease and amnestic mild cognitive impairment

White matter abnormalities represent early neuropathological events in neurodegenerative diseases such as Alzheimer''s disease (AD), investigating these white matter alterations would likely provide valuable insights into pathological changes over the course of AD. Using a novel mathematical framework called “Director Field Analysis” (DFA), we investigated the geometric microstructural properties (i.e., splay, bend, twist, and total distortion) in the orientation of white matter fibers in AD, amnestic mild cognitive impairment (aMCI), and cognitively normal (CN) individuals from the Alzheimer''s Disease Neuroimaging Initiative 2 database. Results revealed that AD patients had extensive orientational changes in the bilateral anterior thalamic radiation, corticospinal tract, inferior and superior longitudinal fasciculus, inferior fronto‐occipital fasciculus, and uncinate fasciculus in comparison with CN. We postulate that these orientational changes of white matter fibers may be partially caused by the expansion of lateral ventricle, white matter atrophy, and gray matter atrophy in AD. In contrast, aMCI individuals showed subtle orientational changes in the left inferior longitudinal fasciculus and right uncinate fasciculus, which showed a significant association with the cognitive performance, suggesting that these regions may be preferential vulnerable to breakdown by neurodegenerative brain disorders, thereby resulting in the patients'' cognitive impairment. To our knowledge, this article is the first to examine geometric microstructural changes in the orientation of white matter fibers in AD and aMCI. Our findings demonstrate that the orientational information of white matter fibers could provide novel insight into the underlying biological and pathological changes in AD and aMCI.     

半自动MRI定量方法测定脑白质高信号体积与病变定性评分的相关性

背景：在磁共振T2加权像和液体衰减反转恢复像中脑白质病变表现为白质高信号,目前对脑白质高信号体积、部位与认知功能损害的关系仍存在争议。 目的：以头颅磁共振对皮质下缺血性脑血管病患者白质高信号进行定量和定性测定,分析高信号体积和部位与认知损害的关系。 设计、时间及地点：于2007-12/2008-09在河北省人民医院神经内科完成。 对象：依据影像学诊断标准确定皮质下缺血性脑血管病53例,记录症状和体征,并进行神经心理学评估。 方法：采用美国GE公司生产的半自动1.5T MRI机对患者行头MRI扫描,定量测定脑白质高信号体积,并结合脑白质病变定性评分。 主要观察指标：分析皮质下缺血性脑血管病患者脑白质高信号体积与评分的相关性,以及白质病变与认知损害的关系。 结果：脑白质高信号体积和评分高度相关（rs=0.989, P < 0.001）,两者呈曲线关系。分层多元线性回归分析显示,白质高信号体积、白质高信号总评分的变化可以分别解释简明精神状态检查评分改变的10.5%和6.8%,前者较后者能更敏感地预测简明精神状态检查评分变化。不同区域脑白质病变中,仅基底核区白质高信号评分与简明精神状态检查评分有关（t=-2.126, P=0.039）,其他各区域白质高信号评分均非简明精神状态检查评分独立预测指标。 结论：脑白质高信号体积与评分均可应用于脑白质病变的测定,前者测定较脑白质高信号评分更敏感;皮质下缺血性脑血管病患者认知功能损害随着脑白质病变的增多,尤其是基底核区白质病变的增多而加重。     

White matter changes in 80 mild cognitive impairment patients using magnetic resonance imaging

BACKGROUND： Many studies have suggested that one possible etiology of mild cognitive impairment is small vessel cerebrovascular disease, which is associated with small subcortical infarcts and white matter abnormalities. These white matter changes have been detected as white matter hyperintensity （WMH） using magnetic resonance imaging. WMH may be associated with frontal lobe dysfunction. OBJECTIVE： To examine white matter changes in mild cognitive impairment patients of different subtypes, and to evaluate the correlation between white matter changes and neuropsychological characteristics, demographic information, vascular risk factors, and mild cognitive impairment subtypes. DESIGN, TIME AND SETTING： The neurophysiological, comparison study was performed at the Department of Neurology Memory Clinic, Ulsan University Hospital, South Korea, between March 2007 and March 2008. PARTICIPANTS： Out of a total of 83 subjects with clinically diagnosed mild cognitive impairment at the out-patient clinic, 3 subjects with severe WMH were excluded. A total of 80 subjects were included in this study. No patients suffered from cognitive impairment induced by neurological diseases, mental disorders, or somatic diseases. In accordance with magnetic resonance imaging results, the patients were assigned to two subtypes： 56 subjects without WMH and 24 subjects with WMH. METHODS： All patients were subjected to a standard neuropsychological battery using the Korean version of the Mini-Mental State Examination, Clinical Dementia Rating, and comprehensive Seoul Neuropsychological Screening Battery. The Clinical Dementia Rating reflected general cognitive function of patients. Results from the Seoul Neuropsychological Screening Battery reflected attention, language function, visuospatial function, verbal memory, nonverbal memory, long-term memory, and frontal/executive function. Magnetic resonance imaging was used to map changes in the brain. MAIN OUTCOME MEASURES： The association between various white matter changes and neuropsychological characteristics, demographic information, vascular risk factors, and mild cognitive impairment subtypes was measured, based primarily on neuropsychological profiles using statistical methods. RESULTS： WMH was significantly associated with neuropsychological characteristics in MCI patients （P 〈 0.05 or P 〈 0.01）, in particular with frontal/executive dysfunction. WMH was significantly correlated with age （P = 0.022） and vascular risk factors （P = 0.006）, independent of gender and MCI subtypes. CONCLUSION： WMH was significantly associated with frontal/executive dysfunction in mild cognitive impairment.