存在血管危险因素的老年人脑白质损害与认知功能障碍的关系

目的探讨存在血管危险因素老年人不同程度脑白质损害(WML)与认知障碍的关系。方法选择WML患者195例,根据WML程度分为轻度组(54例),中度组(63例),重度组(78例),另选健康体检者70例作为对照组。所有受试者行神经心理学测试,包括简易智能状态检查量表、蒙特利尔认知评估量表、听觉词语记忆、逻辑记忆、复杂图形记忆、Stroop色词测验、连线测验B、相似性、言语流畅、数字广度、搜钟和画钟测验。结果与对照组比较,随着WML程度加重,轻、中、重度组血管危险因素明显升高(P<0.05);轻度组记忆、注意、语言及部分执行功能评分明显较对照组差(P<0.05,P<0.01),重度组各项测验评分明显较其他各组差(P<0.01)。各项测验评分与WML严重程度评分呈负相关(P<0.01)。结论血管危险因素可加重WML;轻度WML即对认知功能有影响,重度WML表现广泛认知损害;认知障碍程度与WML严重程度呈正相关。

Relationship between cerebral white matter lesions and cognitive function disorder in old people with vascular risk factors

Objective To examine the relationship between cerebral white matter lesions(WML)of different severity and the cognitive impairment in old people with vascular risk factors.Methods According to WML score,195 participants with WML were divided into mild WML group,medium WML group and severe WML group.The control group(n= 70) consisted of healthy old people without WML.All participants underwent neuropsychological tests including Mini Mental State Examination,Montreal Cognitive Assessment,Auditory Verbal Learning Test,Logical Memory Test,Rey-Osterrieth Complex Figure Test,Stroop Colour-Word Test,Trail Making Test(Similarity Test,Animals Category Fluency Test,Digital Span Test,Belling Test and Clock Drawing Test.Results The vascular risk factors increased as WML extent aggravated(P<0.05).Mild WML group had apparent decline in the memory score,attention score and part of the performance function score compared with the control group,the difference was statistically significant (P<0.05,P<0.01).The severe WML group had dramatic decline in all cognitive function scores compared with other groups,the differences were statistically significant.All of the cognitive function scores were inversely correlated with severity of WML(P<0.01).Conclusion Vascular risk factors could aggravate WML.Mild WML could impair cognitive function,while severe WML showed extensive cognitive impairment.Degree of cognitive impairment was positively correlated to severity of WML in old people with vascular risk factors.