脑白质病变对认知功能的影响

目的:探讨不同部位和不同程度脑白质病变(WML)对患者认知功能的影响。方法:选择WML患者75例和正常对照组30例。根据头颅MRIT2加权像及FLAIR像,将WML组患者分为脑室旁白质病变组和深部白质病变组,根据病变严重程度分为轻度、中度及重度组,应用蒙特利尔认知功能评估量表(MoCA)对入选对象进行认知功能评估。结果:与正常对照组相比,WML组MoCA量表总分、视空间与执行功能、语言、延迟回忆和定向功能均降低(P均<0.01);中度、重度病例组注意力、计算功能、抽象功能得分较差(P<0.05),重度病例组命名功能得分下降(P<0.05)。室旁白质病变组MoCA量表总分、计算、语言、抽象、延迟回忆和定向功能较深部白质病变组得分较低,而视空间与执行功能、注意力得分差异无统计学意义。结论:WML患者视空间与执行功能、语言、抽象功能、延迟回忆和定向力等多个认知领域受损;脑室旁和深部WML对认知功能的影响可能有所不同。

Influence of cerebral white matter lesions on cognitive function

Aim:To investigate the cognitive function impairment of patients with cerebral white matter lesion(WML) at different extent and different location.Methods:According to MRI T2 weighted-imaging and FLAIR imaging,75 patients were first classified into 3 subgroups(mild,moderate,and severe) depending on the extent,then were classified into 2 subgroups(periventricular lesions and deep WML) depending on the location.Thirty normal people were regarded as control group.Cognitive performance was assessed using the Montreal Cognitive Assessment(MoCA).Results:Compared with control,WML group had significantly low scores in total MoCA score,visual spatial,executive function,language,memory and orientation.Moderate and severe subgroups had significantly low scores in attention,calculation and abstraction;severe subgroup had significantly low scores in naming(P < 0.05).The periventricular lesion subgroup had significantly low scores in total MoCA score,calculation,language,abstraction,memory and orientation,and insignificantly high scores in visual spatial,executive function or attention compared with deep WML subgroup.Conclusion:Patients with WML undergo cognitive function impairment,especially in visual spatial,executive function,language,abstraction,memory and orientation.Periventricular and deep WML may have different influence on cognitive function.