老年患者代谢综合征与轻度认知功能障碍的相关性研究

Relationship between metabolic syndrome and mild cognitive impairment in elderly patients

目的对老年代谢综合征(MS)患者进行认知功能评价,确定轻度认知功能障碍的发生率,探讨各代谢指标与轻度认知功能障碍(MC I)的关系,为进一步防治MC I提供理论依据。方法采用简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、数字符号转换测验(DST)、听觉词语学习(AVMT)、连线测验(TMT)、Sunderland画钟试验(CDT)、词汇流畅性测验(VFT)等多种神经心理学量表对74例MS患者(MS组)、45例具有单一或两种血管危险因素非MS患者(非MS组)及32例无血管危险因素的老年人(对照组)进行认知功能评定,并测量其腹围、体质量指数(BM I)、血压、空腹血糖(FBG)、血脂等代谢指标水平。结果①MS组与NMS组患者MC I的发病率分别为52.7%、33.3%,两组差异有统计学意义(P<0.01);②MC I患者的腹围、BM I、收缩压(SBP)、舒张压(DBP)、甘油三酯(TG)水平均高于非MC I患者(P<0.05);③MS组与非MS组整体认知功能评分较对照组显著降低(P<0.001),MS组在记忆、定向、注意、执行等认知方面均明显差于非MS组(P<0.01);④MS组与非MS组的MC I患者在MoCA、DST、AVMT、TMT的测定分值有统计学差异(P<0.05);⑤影响MC I患者认知领域的危险因素依次为FBG、血脂、SBP、腹围,并且随着代谢指标水平的增高认知损害的程度加重。结论老年MS患者存在记忆力、注意力、计算力、视觉空间结构等方面的认知功能损害。MC I患者常伴有代谢指标的异常,而且代谢异常指标的数量与认知功能损伤的程度呈正相关。

Objective To evaluate the cognition of Senile Metabolic Syndrome （MS） patients and to investigate the relationship between metabolism-related indices and MCI. Methods 74 cases with MS （MS group）, 45 patients with vascular risk factors （NMS group） and 32 normal controls were enrolled. Minimental state examination （MMSE）, Montreal cognitive assessment （ MoCA）, Digit-Symbol Test （ DST）, Auditory verbal memory test （ AVMT）, Trail making test（TMT）, Sunderland clock drawing test（ CDT）, and verbal Fluency test （VFT） were applied to evaluate cognitive function. Biochemical variables were measured by routine methods. Results① The incidences of MCI in the MS and NMS groups were 52.7% and 33.3% respectively. There was statistical difference in incidence between the two groups （ P 〈 0.01 ） ; ② The levels of waist circumference, body-mass index （ BMI ）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, and triglycerides （TG） in the MCI group were higher than those in the non- MCI group（P 〈0.05） ; ③ The general cognition function in the MS and NMS groups was significantly lower than that in the control group（ P 〈 0. 001 ）. MS cases achieved significantly lower scores than NMS cases in memory, orientation, attention and executive function（ P 〈 0.01 ） ; ④ The scores of MoCA, DST, AVMT and TMT in MS group were lower than those in the NMS group（ P 〈 0.05 ） ; ⑤ The four most related risk factors affecting cognitive domain of MCI patients were FBG, blood lipids, SBP and waist circumference. The severity of cognitive impairment was directly associated with the level of metabolic indexes. Conclusions Elderly patients with metabolic syndrome show a deterioration in memory, calculation, attention and visuospatial perception. Patients with MCI often have accompanying metabolic dysregulation, and there is positive correlation between the number of abnormal metabolism-related indices and the degree of cognitive impairment.