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目的分析不同程度脑白质损害(WML)老年患者认知评分及神经解剖指标的特点及其相互关系。方法根据Fazekas分级标准将151例老年患者分为WML0级组62例、WML1级组46例、WML 2级组43例,分析各组患者蒙特利尔认知评估量表(MoCA)和神经解剖结构的差异及其相互关系。结果与WML 0级组和WML1级组比较,WML 2级组患者各项MoCA评分明显降低(P<0.01)。控制各项脑神经解剖结构指标后,WML分级与MoCA总分显著相关(r=-0.448,P=0.000)。WML2级组与WML 0级组比较,尾状核指数扩大、海马沟回比扩大、腔隙性脑梗死数目增多为独立危险因素。执行功能与皮质下萎缩(P<0.01)、颞叶萎缩及腔隙性脑梗死数目增多(P<0.05)显著相关。结论轻度WML患者认知功能及脑解剖结构无明显改变,中、重度WML患者多领域认知功能出现明显损害同时伴有广泛的脑萎缩,且WML导致的认知障碍独立于脑萎缩,提示额叶皮质-皮质下环路的破坏及对执行功能的影响是中、重度WML患者的显著特征。
Abstract：Objective To analyse the characteristics of neuroanatomy indexes and the relationship between cognitive score and neuroanatomy indexes in elderly people with cerebral white matter lesions (WML) of different degrees.Methods 151 old patients with WML of different severities were rated with the Fazekas scale and divided into WML 0 level(62 cases),WML 1 level(46 cases) and WML 2 level(43 cases) groups.The differences in MoCA score and neuroanatomy structures in different groups were analyzed.Results Compared with WML 0 level group,WML 1 level group had no significant difference in each MoCA score.However the MoCA score of WML 2 level group was significantly decreased compared with WML 0 level group and WML 1 level group(P<0.01).After controlling various neuroanatomy indexes,WML grade was still significantly correlated with cognitive score(r =—0.448,P = 0.000).Compared with WML 0 level group,the caudate nucleus index increased,hippocampal sulcus-gyrus ratio increased,and the number of lacunar infarction(LI) increased and these were the independent risk factors of WML 2 level group.Regression analysis implied that executive function significantly correlated with subcortical atrophy(P<0.01),temporal lobe atrophy and increased number of LI(P<0.05). Conclusion Mild-WML patients have no significant change in cognition and brain atrophy,while moderate-severe WML patients are associated with significant cognitive impairment and brain atrophy, which imply that impaired executive function caused by wrecked frontal cortical and subcortical circuits is the character of moderate-severe WML patients.
[1]Reed BR.Mungas DM,Kramer JH,et al.Profiles of neuropsychological impairment in autopsy-defined Alzheimer's disease and cerebrovascular disease.Brain,2007,130:731-739.
[2]Moorhouse P,Rockwood K.Vascular cognitive impairment: current concepts and clinical developments.Lancet Neurol, 2008,7:246-255.
[3]Mok V.Wong KK.Xiong Y.et al.Cortical and frontal atrophy are associated with cognitive impairment in age-related confluent white-matter lesion.J Neurol Neurosurg Psychiatry, 2011,82:52-57.
[4]Appelman AP,Vincken KL,van der Graaf Y,et al.White matter lesions and lacunar infarcts are independently and differently associated with brain atrophy:the SMART-MR study. Cerebrovasc Dis,2010,29:28-35.
[5]Hamano K,lwasaki N,Takeya T,et al.A comparative study of linear measurement of the brain and three-dimensional measurement of brain volume using CT scans.Pediatr Radiol, 1993,23:165-168.
[6]Gomori JM.Steiner T,Melamed E,et al.The assessment of changes in brain volume using combined linear measurements. A CT-scan study.Neuroradiology,1984,26:21-24.
[7]Saka E,Dogan EA,Topcuoglu MA,et al.Linear measures of temporal lobe atrophy on brain magnetic resonance imaging (MRI) but not visual rating of white matter changes can help discrimination of mild cognitive impairment(MCl) and Alzheimer's disease(AD).Arch Gerontol Geriatr,2007,44:141- 151.
[8]Nasreddine ZS,Phillips NA.Bedirian V,et al.The Montreal Cognitive Assessment,MoCA:a brief screening tool for mild cognitive impairment.J Am Geriatr Soc,2005,53:695-699.
[9]温洪波,张振馨,牛富生,等.北京地区蒙特利尔认知量表的应用研究.中华内科杂志,2008,47:36-39.
[10]Wiszniewska M,Devuyst G,Bogousslavsky J,et al.What is the significance of leukoaraiosis in patients with acute ischemic stroke? Arch Neurol,2000,57:967-973.
[11]Jokinen H.Kalska H,Mantyla R,et al.Cognitive profile of subcortical ischaemic vascular disease.J Neurol Neurosurg Psychiatry,2006,77:28-33.
[12]Tullberg M,Fletcher E,De Carli Cet al.White matter lesions impair frontal lobe function regardless of their location.Neurology, 2004,63:246-253.
[13]Tierney MC,Black SE,Szalai JP,et al.Recognition memory and verbal fluency differentiate probable Alzheimer disease from subcortical ischemic vascular dementia.Arch Neurol, 2001,58:1654-1659.
[14]Appelman AP,Exalto LG,van der Graaf Y,et al.White matter lesions and brain atrophy:more than shared risk factors? A systematic review.Cerebrovasc Dis,2009,28:227 242.
[15]Akisaki T.Sakurai T.Takata T,et al.Cognitive dysfunction associates with white matter hyperintensities and subcortical atrophy on magnetic resonance imaging of the elderly diabetes mellitus Japanese elderly diabetes intervention trial(J-EDIT). Diabetes Metab Res Rev,2006,22:376-384.
[16]Ikram MA,Vrooman HA,Vernooij MW.et al.Brain tissue volumes in relation to cognitive function and risk of dementia. Neurobiol Aging,2010,31:378-386.
[17]Carey CL,Kramer JH.Josephson SA.et al.Subcortical lacunes are associated with executive dysfunction in cognitively normal elderly.Stroke,2008,39:397-402.
[18]Chen Y,Chen X,Xiao W,et al.Frontal lobe atrophy is associated with small vessel disease in ischemic stroke patients.Clin Neurol Neurosurg,2009,111:852-857.
[19]Oosterman JM,Vogels RL,van Harten B,et al.The role of white matter hyperintensities and medial temporal lobe atrophy in age-related executive dysfunctioning.Brain Cogn, 2008,68:128-133.
基本信息:
中图分类号:R749.1
引用信息:
[1]王月菊,李鹏,侯宝元,等.不同程度脑白质损害老年患者认知评分与神经解剖指标的关系[J].中华老年心脑血管病杂志,2011,13(06):530-534.
基金信息:
苏州市科技计划项目(2008SS08012)
2011-06-15
2011-06-15