急性腔隙性脑梗死伴脑白质病变对认知功能的变化影响

The combined effects of acute first ever lacunar infarction and cerebral white matter lesions on cognitive function impairment

目的探讨急性腔隙性脑梗死(LI)伴脑白质病变(WML)患者的认知功能障碍特点。方法收集137例患者和正常对照组30例,根据头颅MRIT2加权像及FLAIR像,将病例组分为LI组、WML组和LI合并WML组,应用蒙特利尔认知评估量表(MoCA)进行认知评估。结果与对照组相比,WML组的延迟回忆与语言评分明显下降(P<0.01);LI组患者注意计算、语言、执行功能评分显著降低(P<0.01);LI合并WML组患者延迟记忆、视空间与执行功能评分显著降低(P<0.01)。与LI组和WML组相比,执行功能障碍在LI合并WML组更明显(P<0.01)。结论LI合并WML可导致患者认知功能障碍,主要表现为延迟记忆、视空间与执行等认知功能的受损;MoCA在皮层下缺血性脑血管病引起的血管性认知障碍的评定中具有很大的优势。

[ Abstract] Objective To investigate the association between the cognitive function impairment and patients with both acute first ever lacunar infarction and cerebral white matter lesions. Methods According to MRI T2 weighted-imaging and FLAIR imaging, 137 pa- tients were classified into 3 groups： （lacunar infarction, LI）, （white matter lesions, WML）, LI and WML. Thirty normal persons were regarded as control group. Cognitive performance was assessed with Montreal Cognitive Assessment at presentation. Results Compared with control subject, group with WML had significantly low scores in memory and language; group with LI had significantly low scores in calculation, language and executive function; group with both LI and WML had significantly low scores in memory, visual spatial and executive function（P 〈0.01）. The patients in group with both LI and WML performed poorer in the executive function（P 〈 0.01 ）. Conclusions Patients with both LI and WML undergo cog- nitive ruction impairment, especially in memory, visual spatial and executive function. Mo- CA have a great advantage of assessing cognitive impairment caused by subcortical ischemic vascular disease.