两种轻度认知损害患者的神经心理学功能比较

背景区别轻度认知损害（mildcognitiveimpairment，MCI）的两种亚型，即遗忘型轻度认知损害（alTlnesticmildcogni—tiveimpairment，aMCI）和小血管型轻度认知损害（MCIassociatedwithsmallvesseldiseases，sv-MCI）将有利于延缓和预防MCI进展为阿尔茨海默病性痴呆和血管性痴呆。目的识别并区分区aMCI与sv-MCI的神经心理学特征。方法从宣武医院神经科门诊就诊患者或在北京社区进行的一项入户调查中选择符合入组标准的被试。根据Pe—tersen诊断标准筛选aMCI患者50例，根据Hachinski诊断标准筛选sv-MCI患者65例。以上两组患者和49名55岁以上没有认知障碍的社区被试一同接受简明精神状态量表（MiniMentalStateExamination，MMSE）检查及画钟测验（ClockDrawingTest，CDT）与听觉词语学习测验（AuditoryVerbalLearningTest，AVLT，评定即刻记忆、延迟回忆和延迟再认能力）。采用单因素方差分析法比较3组被试各项测验的平均得分，如果结果存在明显差异，再进行多个样本两两比较的Tukey法检验。结果aMCI组和SV．MCI组5项测验平均得分均明显低于健康对照组。aMCI组AVLT即刻记忆、延迟回忆和延迟再认测验得分均低于SV．MCI组。在校正了年龄、性别、受教育年限后，上述差异仍旧存在。结论实验结果与既往结果一致，与SV—MCI患者相比，aMCI患者记忆损害更加明显。记忆相关的评估测验，尤其是AVLT，或将有助于区别这两种MCI亚型。

Comparison of the neuropsychological characteristics of two subtypes of mild cognitive impairment

Background： Characterizing the differences between two proposed subtypes of mild Cognitive impairment （MCI） -- amnestic mild cognitive impairment （aMCI） and mild cognitive impairment due to small vessel disease （sv-MCI） -- may help in the effort to prevent progression of MCI to Alzheimer＇s dementia and vascular dementia. Objective： Identify neuropsychological characteristics that discriminate aMCI and sv-MCI. Methods： 50 individuals with aMCI based on Petersen＇s criteria and 65 individuals with sv-MCI based on Hachinski＇s criteria were identified from a general hospital neurology clinic and from a household survey in a rural district in Beijing. These subjects and 49 community members 55 and older without any cognitive problems were administered the Mini Mental State Examination （MMSE）, the Clock Drawing Test （CDT） and the Auditory Verbal Learning Test （AVLT） which assesses immediate recall, delayed recall and delayed recognition. Mean scores of these measures in the three groups of subjects were compared using a one-way analysis of variance （ANOVA） and, if significant, follow-up pairwise comparisons using Tukey testS. Results： Mean scores on all five measures were significantly lower in the two patient groups than in the control group, and the mean subscale scores of the AVLT -- immediate recall, delayed recall and delayed recognition were significantly lower in the aMCI group than in the sv-MCI group, a difference that remained significant after adjusting for age, gender and years of education. Conclusion： These results support previous findings of significantly greater disruption in memory functions among aMCI patients than in sv-MCI patients. Measures of memory functioning, particularly the AVLT, may be useful in distinguishing these two subtypes of MCI.