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（minimentalstate 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。

Study on the Relationship between White Matter Lesions and Cognitive Impairment

Objective To assess the correlation of the white matter lesions and the cognitive function of the patients with small vessel disease. Methods The patients with small vessel disease were chosen from all the outpatients of the Department of Neurology in First Affiliated Hospital of the Medical College of Zhejiang University from October 2009 to December 2009, by the assessments of cognitive function, such as the informant questionnaire on cognitive decline in the elderly(IQCODE), the Mini-Mental State Examination(MMSE), the Clinical Dementia Rating(CDR) and so on, the cerebral magnatic resonance imaging(MRI) and the clinical data. The effect of the different extents and locations of the white matter lesions to the cognitive function was assessed by statistical analysis. Results A total of 147 patients were included in this study, with 33 small vessel disease. Comparing with the normal group, significant differences(P =0.00) were found in the patients with small vessel disease in the remembrance(z =-3.36), the orientation(z =-3.14), the judgement(z =-3.38) and the social activity(z =-3.22). We found significant correlations between the scores of MMSE(r =0.82),the remembrance scores of CDR(r =0.82), the total scores of CDR(r =0.62)and the extent of the periventricular lesions(P =0.00), but the correlations between the deep white matter lesions and the cognitive impairment were middling correlated, as the scores of MMSE(r =0.51, P =0.01), the remembrance scores of CDR(r =0.49, P =0.02). Conclusions The scores of MMSE and the CDR may be predictors to the progress of the white matter lesion, especially the periventricular lesions.