特发性正常颅压性脑积水(iNPH)患者认知障碍特征的临床分析

 目的   对特发性正常颅压性脑积水(idiopathic normal pressure hydrocephalus,iNPH)患者的认知障碍特征进行临床分析,为临床诊疗提供依据。方法  通过多个量表评价23例诊断为疑似iNPH患者的认知功能,对照组为15例性别年龄匹配、经磁共振明确无脑积水表现的病例。采用简易精神状态检查量表评价总体认知功能,Stroop色词测验评估执行功能,听觉词语学习测验评估学习和记忆功能,数字广度测验评估注意功能,改良Rankin量表和日常生活活动能力量表评价整体生活能力。结果   本研究中iNPH患者(iNPH组)的简易精神状态检查量表评分［21.00 (11.00~25.00)］较对照组［28.00(26.00～29.00)］显著下降(P＜0.01);Stroop色词测验中卡片A所耗秒数［59.60(33.60～97.70)］较对照组［32.00 (26.00~39.00)］显著延长(P=0.04),卡片A正确个数［50.00 (46.00～50.00)］较对照组(均为50个)显著下降(P=0.02),完成卡片B所耗秒数［106.00(59.20～227.60)］较对照组［46.00 (37.00~50.00)］显著延长(P＜0.01),完成卡片A及B总耗秒数［177.70(90.00～279.40)］较对照组［75.00 (72.00~89.00)］显著延长(P＜0.01),完成卡片C所耗平均秒数［206.60(99.50～237.10)］较对照组［88.00 (70.00~120.00)］显著延长(P=0.01);听觉词语学习测验中短延迟回忆平均个数,iNPH组(4.18±2.89)较对照组(6.29±2.14)显著下降(P=0.04),长延迟回忆个数［3.50(3.00～5.00)］较对照组［7.00 (6.00~9.00)］显著下降(P=0.01),线索回忆个数［1.50(0.00～4.00)］较对照组［5.50 (3.00~9.50)］显著下降(P=0.02),平均回忆总个数(即前5次回忆个数之和)［15.00(11.00～23.00)］较对照组［24.00 (20.00~37.00)］显著下降(P=0.04);数字广度测验中倒背得分(3.04±2.12)较对照组(4.15±0.99)显著下降(P=0.03);改良Rankin评分［3.00 (2.00~4.00)］较对照组(均为0分)显著增高(P＜0.01);ADL评分［85.00(70.00～95.00)］较对照组(均为100分)显著下降(P＜0.01)。结论  iNPH患者存在认知功能下降,表现为执行功能障碍、记忆损害、注意损害及日常生活能力下降。

A clinical analysis on the characteristics cognitive impairment in idiopathic normal pressure hydrocephalus (iNPH)

Objective    To analyze the characteristics of cognitive impairment in patients with idiopathic normal pressure hydrocephalus (iNPH) in order to provide evidence for clinical diagnosis and treatment of iNPH.Methods    The cognitive function of 23 patients with suspected iNPH were evaluated by multiple scales and match with 15 control subjects without hydrocephalus.The mini mental state exam (MMSE) was used to assess total cognitive function,Stroop color word test (CWT) was used to assess evaluate executive function,auditory verbal learning test (AVLT) was used to assess learning and memory function,a digital span test (DST) was used to assess evaluate attention function,and modified Rankin scale (mRS) and activity of daily living scale (ADL) were used to assess living ability.Results    In our study,the MMSE scores,correct number of CWT-card A,mRS scores and ADL socres were significantly decreased in patients with iNPH compared with controls ［MMSE scores:21.00 (11.00-25.00) vs.28.00 (26.00-29.00),P＜0.01;correct number of CWT-card A:50.00 (46.00-50.00) vs.50.00 (50.00-50.00),P=0.02;mRS scores:3.00 (2.00-4.00) vs.0.00 (0.00-0.00),P＜0.01;ADL socres:85.00 (70.00-95.00) vs.100.00 (100.00-100.00),P＜0.01］.The average time of CWT-card A/B/A+B/C were significantly increased in patients with iNPH compared with controls ［CWT-card A:59.60 (33.60-97.70) vs.32.00 (26.00-39.00),P=0.04;CWT-card B:106.00 (59.20-227.60) vs.46.00 (37.00-50.00),P＜0.01;CWT-card A+B:177.70 (90.00-279.40) vs.75.00 (72.00-89.00),P＜0.01;CWT-card C:206.60 (99.50-237.10) vs.88.00 (70.00-120.00),P=0.01］.The average score short delay memory,long delay memory,cue recall and total memory (include previous five recalls) in auditory verbal learning test were significantly decreased in patients with iNPH compared with controls ［short delay memory:4.18±2.89 vs.6.29±2.14,P=0.04;long delay memory:3.50 (3.00-5.00) vs.7.00 (6.00-9.00),P=0.01;cue recall:1.50 (0.00-4.00) vs.5.50 (3.00-9.50),P=0.02;total memory:15.00 (11.00-23.00) vs.24.00 (20.00-37.00),P=0.04］.Backword in digit span test was significantly decreased in patients with iNPH compared with controls (3.04±2.12 vs.4.15±0.99,P=0.03).Conclusions    Patients with iNPH had a decline of cognitive function,manifested as severe deflicits in executive function,impairment of memory,attention and ability of daily living.