无症状与伴认知功能损害的脑白质疏松症对比分析

Comparative analysis between leukoaraiosis subjects with and without cognitive impairment

目的 探讨脑白质疏松症 (LA)伴认知功能损害的特点并分析相关因素。方法 根据临床症状和认知功能检查将 4 6例LA分成 2组 ,即LA伴认知功能损害组 2 5例和LA不伴认知功能损害组 2 1例 ,采用简易智能精神状态检查量表 (MMSE)、剑桥认知检查量表 (CAMCOG)评定认知功能 ,老年抑郁量表 (GDS)评定抑郁症状 ,并调查血管危险因素以及分析神经影像学资料。结果 在语言 (尤其语言表达方面 )、记忆力和知觉方面 ,2组之间差异有显著性 (P <0 0 1) ;在定向力、远近记忆力、注意力、执行功能和抽象思维等方面 ,2组之间差异有显著性 (P <0 0 5 ) ;而在语言理解、学习记忆和计算方面 2组之间差异无显著性 (P >0 0 5 )。 2组中认知方面差异与年龄、性别、体重指数、血管危险因素、伴随抑郁症状等无关 (P >0 0 5 ) ,与受教育程度 (P <0 0 1)、LA分级 (P <0 0 0 1)以及是否伴发腔隙性脑梗死有关 (P <0 0 1)。结论 LA出现的认知功能损害涉及多个认知区域 ,LA伴认知功能损害与低教育程度 ,LA损害范围较大 ,以及合并存在腔隙性脑梗死等有关。

Objective To study the cognitive impairment and correlation factors of leukoaraiosis (LA) subjects. Methods Twenty-five LA subjects with cognitive impairment and 21 LA subjects without cognitive impairment were evaluated. Data from mini mental state examination (MMSE), cambridge cognitive examination (CAMCOG), geriatric depression scale (GDS), vascular risk factors (VRFs) and neuroimaging were analyzed. Results There were significant differences between LA subjects with and without cognitive impairment (Student's t-test,P<0.01) in tests that evaluate language (especially expression), memory and perception functions. The LA subjects with cognitive impairment showed poorer performance (P<0.05) in the tests evaluating orientation, remote and recent memory, attention, praxis and abstract thinking functions. No significant differences in the tests evaluating learning memory, language comprehension and calculation functions were found in the two groups (P>0.05). Age, sex, body mass index (BMI), VRFs and depression symptoms didn't affect cognitive impairment of LA subjects (P>0.05), while educational level (P<0.01), grades of LA (P<0.001) and the presence of lacunar infarcts (P<0.01) had an effect on cognitive impairment of LA subjects. Conclusion There are multiple domains of cognitive impairment in LA subjects. The cognitive impairment of LA subjects depends upon educational level, degree of LA and/or the presence of lacunar infarcts.