痴呆简易筛查量表及P300检测对血管性痴呆患者认知功能的评价

Evaluation of cognitive function of vascular dementia patients with Brief Screening Scale for Dementia and P300 determination

目的:分析血管性痴呆患者痴呆简易筛查量表及P300改变的特点,以期提高血管性痴呆的诊断水平。方法:选择2000-11/2002-03解放军第三军医大学新桥医院神经内科门诊或住院的血管性痴呆患者30例(符合加利福尼亚阿尔茨海默病诊断和治疗中心对于血管性痴呆的诊断标准)和无明显认知功能障碍的脑梗死患者30例(均经CT/MRI证实)及同期本院的体检人员30例,应用痴呆简易筛查量表测评受试者认知功能状态。对其各项指标,即时间定向、地点定向、物体命名、语言即刻记忆、短程记忆、计算、语言理解、图片、常识分别计分后进行统计分析。应用肌电-诱发电位仪的听觉oddball程序检测P300。记录电极放在Cz点(中央中线点),前额作为参考部位。非靶刺激频率为1kHz,靶刺激频率为2kHz,靶刺激随机分布于非靶刺激中,靶刺激出现概率占刺激总数20%,刺激强度为110dB,滤波带宽1～50Hz,叠加30～50次。记录到稳定的P300后,测定P300峰潜伏期,即刺激的起始点至波峰顶点之间的时间。结果:血管性痴呆组和脑梗死对照组患者和正常对照组均完成量表评定和P300检测,全部进入结果分析。①血管性痴呆组痴呆简易筛查量表评分明显低于脑梗死对照组,差异有显著性意义[(16.90±3.32),(28.40±1.16)分,Z=-6.690,P<0.01],也显著低于正常对照组,差异有显著性意义[(16.90±3.32),(29.90±0.31)分,Z=-6.986,P<0.01]。脑梗死对照组痴呆简易筛查量表评分明显低于正常对照组,差异有显著性意义(Z=-5.705,P<0.01)。②血管性痴呆组P300潜伏期明显长于脑梗死对照组,差异有显著性意义[(438.04±42.82),(367.77±29.14)ms,Z=6.237,P<0.01];也明显长于正常对照组,差异有显著性意义[(438.04±42.82),(329.53±35.04)ms,Z=6.532,P<0.01]。脑梗死对照组P300潜伏期明显长于正常对照组,差异有显著性意义(Z=6.128,P<0.01)。③血管性痴呆组时间定向、地点定向、语言即刻记忆、短程记忆、计算、语言理解、图片、常识评分均明显低于脑梗死对照组,差异均有显著性意义(秩和检验,P<0.01)。血管性痴呆组时间定向、地点定向、语言即刻记忆、短程记忆、计算、语言理解、图片、常识评分均明显低于正常对照组,差异有显著性意义(秩和检验,P<0.01)。脑梗死对照组短程记忆、计算和识图评分明显低于正常对照组,差异有显著性意义(秩和检验,P<0.05或P<0.01)。结论:血管性痴呆患者以记忆减退、语言认知相关的功能障碍和视觉空间认知功能障碍为突出表现。认知功能障碍是脑梗死患者的常见并发症。P300可反血管性痴呆患者和脑梗死患者认知功能状况。

AIM： To analyze the characteristics of Brief Screening Scale for Dementia （BSSD） and P300 change in the patients with vascular dementia for promoting the diagnostic quality of vascular dementia. METHODS： Totally 30 patients with vascular dementia, 30 cerebral infarction patients without markedly cognitive deficits, and 30 normal people, who came from the same hospital from November 2000 to March 2002, were enrolled in the study. BSSD was used to evaluate their cognitive function. Time orientation, place orientation, object denomination, immediate memory of language, short-range memory, calculation, language comprehension, card and common sense of BSSD were analyzed after counting scores. P300 was measured with auditory sense oddball program of myoelectricity-evokod potential apparatus. Recording electrode was at central zone （Cz） and prefrons as reference part. Frequency of non-target stimulation was 1 kHz and frequency of target stimulation was 2 kHz. Target stimulation was randomly distributed in non-target stimulation. 20% target stimulation in the general stimulation appeared with the stimulus intensity of 110 dB, band width of smoothing of 1-50 Hz, superposition of 30-50 times. Afidr stable P300 was recorded, latency of P300 peak, which was the duration from initiation of stimulation to spinnacle of wave peak, was measured. RESULTS： Patients in the vascular dementia group and cerebral infarction control group as well as persons in the normal control group received scale identification and P300 determination, and were involved in the result analysis. ①The vascular dementia patients had lower scores of BSSD as compared with the patients in the cerebral infarction control group, and there was significant difference [（16.90±3132）, （28.40±1.16） points,Z=-6.690, P 〈 0.01], and the score was also markedly lower than the normal control group with significant difference [（16.90±3.32）, （29.90±0.31） points, Z=-6.986, P 〈 0.01]. The scores of BSSD in the cerebral infarction control group were remarkably lower than the normal control group, and there was significant difference （Z=-5.705, P 〈 0.01 ）. ② The P300 latency in the vascular dementia group was obviously longer than that in the cerebral infarction control group, and there was significant difference [（438.04±42.82）, （367.77±29.14） ms, Z=6.237, P 〈 0.01], and the latency was also longer than that in the normal control group with significant difference [（438.04±42.82）, （329.53±35.04） ms, Z=6.532, P 〈 0.01]. The P300 latency in the cerebral infarction control group was distinctly longer than that in the normal control group, and there was significant difference （Z=6.128, P 〈 0.01 ）. ③The scores of time orientation, place orientation, immediate memory of language, short-range memory, calculation, language comprehension, card and common sense in the vascular dementia group were dramatically lower than that in the cerebral infarction control group, and there was significant difference （rank-sum test, P 〈 0.01 ）. The scores of time orientation, place orientation, immediate memory of language, shortrange memory, calculation, language comprehension, card and common sense in the vascular dementia group were dramatically lower than that in the normal control group, and there was significant difference （rank-sum test, P 〈 0.01）. The scores of short-range memory, calculation and recognition of pictures in the cerebral infarction control group were significantly lower than that in the normal control group, and there was significant difference （rank-sum test ,P 〈 0.05 or P 〈 0.01 ）. CONCLUSION： Disorder in memory, attention and the functions related to language and visuospatial cognition are prominent in the vascular dementia patients. Cognitive disorder is a common complication in cerebral intaretion patients, P300 is a good parameter to reflex the cognition of vascular dementia patients and cerebral infarction patients.