不同程度脑白质损害老年患者认知评分与神经解剖指标的关系

The relationship between cognitive score and neuroanatomy indexes in elderly patients with white matter lesions of different degrees

目的分析不同程度脑白质损害(WML)老年患者认知评分及神经解剖指标的特点及其相互关系。方法根据Fazekas分级标准将151例老年患者分为WML0级组62例、WML1级组46例、WML 2级组43例,分析各组患者蒙特利尔认知评估量表(MoCA)和神经解剖结构的差异及其相互关系。结果与WML 0级组和WML1级组比较,WML 2级组患者各项MoCA评分明显降低(P<0.01)。控制各项脑神经解剖结构指标后,WML分级与MoCA总分显著相关(r=-0.448,P=0.000)。WML2级组与WML 0级组比较,尾状核指数扩大、海马沟回比扩大、腔隙性脑梗死数目增多为独立危险因素。执行功能与皮质下萎缩(P<0.01)、颞叶萎缩及腔隙性脑梗死数目增多(P<0.05)显著相关。结论轻度WML患者认知功能及脑解剖结构无明显改变,中、重度WML患者多领域认知功能出现明显损害同时伴有广泛的脑萎缩,且WML导致的认知障碍独立于脑萎缩,提示额叶皮质-皮质下环路的破坏及对执行功能的影响是中、重度WML患者的显著特征。

Objective To analyse the characteristics of neuroanatomy indexes and the relationship between cognitive score and neuroanatomy indexes in elderly people with cerebral white matter lesions（WML） of different degrees. Methods 151 old patients with WML of different severities were rated with the Fazekas scale and divided into WML 0 level（62 cases）,WML 1 level（46 cases） and WML 2 level（43 cases） groups. The differences in MoCA score and neuroanatomy struc- tures in different groups were analyzed. Results Compared with WML 0 level group,WML 1 level group had no significant difference in each MoCA score. However the MoCA score of WML 2 level group was significantly decreased compared with WML 0 level group and WML 1 level group （P 〈 0.01）. After controlling various neuroanatomy indexes,WML grade was still significantly correlated with cognitive score （r =- 0. 448,P = 0. 000）. Compared with WML 0 level group,the caudate nucleus index increased, hippocampal sulcus-gyrus ratio increased, and the number of lacunar infarction（LI） increased and these were the independent risk factors of WML 2 level group. Regression analysis implied that executive function significantly correlated with subcortical atrophy （P 〈 0. 01）, temporal lobe atrophy and increased number of LI （P 〈 0. 05）. Conclusion Mild-WML patients have no significant change in cognition and brain atrophy,while moderate-severe WML patients are associated with significant cognitive impairment and brain at- rophy,which imply that impaired executive function caused by wrecked frontal cortical and subcortical circuits is the character of moderate-severe WML patients.