Alzheimer病与血管性痴呆的认知及生活功能变化的随访研究

A follow-up study of cognitive function and life function in Alzheimer’s disease and vascular dementia.

目的 探讨Alzheimer病(AD)与血管性痴呆(VD)的认知功能和生活功能的衰退模式。方法 入组时、1年后,采用痴呆严重程度临床评定量表(CDR)、简易智能状态检查量表(MMSE)、生活功能量表(ADL)对住院的Alzheimer病与血管性痴呆患者进行检查。患者出院1 年后对原有样本进行面检随访研究,并同时进行上述量表的测查,并分析对认知功能及生活功能的影响因素。结果 1年后AD病死率为3.45%(2/58)、VD病死率为12.12%(4/33)。入组时AD与VD组比较,各痴呆严重程度之间、MMSE总分差异无显著意义(均P>0.05),两者均以记忆力的减退最为明显, 1年后AD组MMSE总分及地点定向、图形描述因子分下降较为显著(P<0.05),而VD组MMSE总分及个因子分下降不明显(均P>0.05),AD组ADL总分及躯体生活功能、工具性生活功能因子分均有不同程度的升高(P<0.05),而VD组ADL总分及躯体生活功能、工具性生活功能因子分没有明显的变化(均P>0.05)。MMSE分与年龄、病程、GDS评级正相关,与ADL总分负相关,ADL总分与年龄、病程、GDS评级正相关,与MMSE分负相关。反映VD患者的空间感知能力损害较AD患者更为明显。结论 AD与VD患者的认知功能和日常生活能力减退各具其特点,这些特点有助于AD和VD的诊断和治疗。

Objective To explore the retrograde mode of cognitive function and life function in patients with Alzheimer’s disease (AD) and vascular dementia (VD). Methods All patients with AD or VD were assessed with Clinical Dementia Rating Scale(CDR), Mini-Mental State Examination(MMSE) and Activity of Daily Living Scale(ADL). The factors related with cognitive function and life function were analyzed.Results Mortality of the patients was 5.49% after one year, AD 3.45%(2/58), VD 12.12%(4/33). At the beginning of the study, the levels of dementia and the total score of MMSE had no significantly differences between AD group and VD group ( P >0.05). Both groups were characterized by decreased memory.After one year, the total score of MMSE and factor scores of place-orientation and describing graphics had obviously declined in AD group ( P <0.05), the total score of ADL and factor scores of physical life function and capability of using tools had significantly increased ( P <0.05). Meanwhile, the drop of total score of MMSE and factor scores of place-orientation and describing graphics was not obvious in VD group ( P >0.05), the total scores of ADL and factor scores of physical function and capability of using tools had not distinct changes ( P >0.05).Such results were not found in VD group.The score of MMSE was positively correlated with age, duration of illness, grade of GDS,and negatively with total score of ADL.Total score of ADL was positively correlated with age, duration of illness, grade of GDS and negatively with the score of MMSE. It indicated that the impairment of ability of space perception in VD was much obvious than that in AD. Conclusion The degression of cognitive function and ability of daily living has respective characteristics in patients with AD or VD. These characteristics are useful to assist diagnosing and treating AD and VD.