卒中后认知障碍患者头部磁共振成像和经颅多普勒超声的改变

目的探讨非痴呆性血管性认知功能障碍（VCIND）患者头部MRI和经颅多普勒超声（TCD）的变化及其与认知功能障碍之间的关系。方法对52例卒中后VCIND患者的头部MRI、TCD检查结果进行回顾性研究，并与40例非VCIND卒中患者及42例体检对照者头部MRI、TCD检查结果进行对比。使用简易智能状态检查量表（MMSE）、画钟测验（CDT）评定智能状态。结果①VCIND卒中组患者额颞叶病变比例高于非VCIND卒中组（46．2％和22．5％，χ^2=5．50，P〈0．05），多发病灶者比例也高于非VCIND卒中组（63．5％和40．0％^2=5．00P〈0．05）。在VCIND卒中组内，病变位于额颞叶者认知功能减退[MMSE为（20．6±1．3）分，CDT为（1．8±1．0）分]与病变位于其他部位者[MMSE为（24．2±1．3）分，CDT为（2．4±0．7）]比较，均P〈0．05；多发病灶者[MMSE为（21．7±1．6）分，CDT为（2．0±1．0）分）]与单发病灶者[MMSE为（23．8±1．1）分，CDT为2．4±1．0）分]比较，MMSE的P〈0．01，CDT的P〉0．05。②与对照组（26．2％）和非VCIND卒中组（62．5％）比较，VCIND卒中组患者血流动力学异常发生率（90．4％）更高,^2=40．63，均P〈0．05。③VCIND卒中组和非VCIND卒中组患者的大脑前、中、后动脉的平均血流速度均较对照组降低，与非VC／ND卒中组相比，VCIND卒中组大脑前动脉、大脑中动脉平均血流速度降低，差异有统计学意义（均P〈0．05）。结论①额颞叶病变及病灶数量是影响VCIND的重要因素。（2）VCIND卒中组患者存在明显血流动力学异常和脑供血不足表现，颈内动脉系统供血不足可能与卒中后认知功能受损有关。

Changes of head magnetic resonance imaging and transcranial Doppler in patients with post-stroke cognitive impairment

Objective To investigate the changes of head magnetic resonance imaging （MRI） and transcranial Doppler （TCD） in patients with vascular cognitive impairment but no dementia （VCIND） and their relationship with cognitive impairment. Methods The head MRI and TCD in 52 patients with post- stroke VCIND were studied retrospectively, and were compared to the findings of head MRI and TCD of 40 stroke patients without cognitive impairment and 42 healthy controls. The Mini-Mental State Examination （MMSE） and the Clock Drawing Test （CDT） were used to assess the mental status. Results （1）Not only the proportion （46.2%） of the lesions of frontal and temporal lobe in the VCIND group was higher than that （22.5%） in the stroke group （χ^2 =5.50,P 〈0. 05）, but also the proportion （63.5%） in patients with multiple infarcts was higher than that （40%） in the stroke group （χ^2 = 5.00,P 〈 0.05 ）. The cognitive decline in the patients whose foei located in the frontal and temporal lobes （ MMSE= 20. 6 ＋ 1.3, CDT = 1.8 ＋ 1.0） in the VCIND group compared to those in the other parts （MMSE =24. 2 ＋ 1.3, and CDT = 2.4 ＋ 0. 7, all P 〈 0.05） ; and the patients with multiple loci （ MMSE = 21.7 ＋ 1.6, and CDT = 2.0 ＋- 1.0） compared to those with single focus （ MMSE=23. 8 ＋ 1. 1, CDT = 2. 4 ＋ 1.0） （P 〈 0. 05 and P 〉 0. 05）. （1）As compared to the normal controls group （26.2%） and the stroke group （62.5%）, the incidence of abnormal hemodynamics （90.4%） was higher in the VCIND group （χ^2 = 40. 63, P 〈 0. 05 ）. （2）The mean flow velocities of the anterior and middle cerebral arteries in the VCIND and stroke groups were lower than those in the control group. The mean flow velocities of the anterior and middle cerebral arteries were decreased in the VCIND group compared to the stroke group, and there were significant differences between them （ P 〈 0.05 ）. Conclusion （1） The lesions of frontal and temporal lobe and the numbers of lesions are the important factors affecting VCIND. （2） The VCIND group had obvious abnormal hemodynamics and cerebral circulation insufficiency. The insufficiency of the internal carotid artery may be associated with the impaired cognitive function after stroke.