皮质下缺血性血管病的神经心理特征

The Neuropsychological Characteristics of Subcortical Ischemic Vascular Disease

目的探讨皮质下缺血性血管病（subcortical ischemic vascular disease，SIVD）的认知和情感特征。方法对符合SIVD标准的缺血性卒中患者进行详细的临床访谈和神经心理、神经精神检查。结果50例患者平均年龄（70±8）岁，男性占78％，轻度SIVD 20例（40％），中重度30例（60％）。33例诊断为血管性认知功能障碍（vascular cognitive impairment，VCI），其中24例（72．7％）为血管性认知损害非痴呆（vascular cognitive impairment no dementia，V-CIND）。在VCI患者中，11例（33．3％）为单一认知域损害，22例（66．7％）为多认知域受损，执行和记忆功能是损害最突出的认知域。本组患者没有语言和空间能力的单独受累。VCI患者39．3％伴抑郁，而非VCI者仅11．8％伴抑郁，差异有统计学意义（P=0．043）。妄想、幻觉、过度兴奋和夜间不寻常活动仅见于VaD患者。中重度SIVD中患VCI比例显著高于轻度者（P=0．002），伴抑郁的比例亦有增高的趋势（P=0．059）。结论认知障碍在SIVD中常见，但多为V-CIND，以执行功能和记忆损害最为突出，易伴抑郁，提示额叶皮质皮质下环路损伤可能是两者共同损害的主要机制。

Objective To investigate cognitive and emotional charcteristics of subcortical ischemic vascular disease （SIVD）. Methods Detailed clinical interviews, neuropsychological and psychiatric assessments were administrated on ischemic stroke patients who fulfilled the criteria of SIVD.Results Mean age of 50 patients was 70.3±7.7 years old, 78% were male, 20 patients（40%） were with mild SIVD while the rest 30 were with moderate to severe SIVD. Among 33 patients whom were diagnosed as vascular cognitive impairment（VCI）, 24（72.7%） were diagnosed as vascular cognitive impairment no dementia（V-CIND）, 11（33.3%）were with single cognitive domain deficit, and 22（66.7%）were with multi-domain deficits. Executive function and memory were the most prominently impaired domains. Neither language nor spatial function was impaired separately among them. 13 VCI patients were depressed（39.3%） while 2 out of 17 SIVD patients with normal cognition were depressed（P=0.043）. Delusions, hallucination, elation/euphoria and nighttime behavior disorders were only seen in vascular dementia patients. The proportion of cognitive impairment was significantly higher in patients with moderate to severe SIVD than those with mild SIVD（P=0.002）. There was a tendency for more depression among patients with moderate to severe SIVD than those with mild SIVD（P=0.059）. Conclusion Cognitive impairments, especially the V-CIND, were common in SIVD patients. Executive function and memory were the most vulnerable cognitive domains. Cognition impairment paralleled with depression among SIVD patients indicates that frontal cortical-subcortical circuit injury might be the mechanism underneath.