脑白质疏松特征性认知功能损害的研究

Leukoaraiosis Features of Cognitive Impairment

目的：探讨脑白质疏松（LA）特征性认知功能损害,极其严重程度与认知功能障碍的关系,以及脑白质疏松作为血管性认知功能障碍早期预测因子的价值。方法：选择LA患者50例为A组,并按Aharon-Ptretz分级标准进行分级分组;选择腔隙性脑梗死患者50例为B组;选择头颅CT正常老年人50例为C组。全部用蒙特利尔认知评估量表（MoCA）对认知功能进行评分。结果：①A、B、C 3组间,除命名得分在C组与B组之间差异无统计学意义（P〉0.05）,3组的MoCA总分、各分项得分均差异有统计学意义（P〈0.05）,尤其注意力、延迟回忆在A组表现尤为突出,与B组和C组具差异有统计学意义（P〈0.01）,此外时间与地点定向力损害也较明显;②在LA分级分组研究中,0~1级认知功能评分MoCA得分正常,2级认知功能评分MoCA得分与0~1级相比,除记忆分值差异有统计学意义（P〈0.05）,其余各项与0~1级相比无统计学意义（P〉0.05）,3级认知功能评分MoCA得分与1级相比较,记忆、语言、注意等差异有统计学意义（P〈0.05）,余各项无统计学意义（P〉0.05）,4级认知功能评分MoCA得分与1级相比较,记忆、语言、注意、视空间执行能力、定向力差异都有统计学意义（P〈0.05）,3级认知功能评分MoCA得分与2级相比较,记忆、语言、注意差异有统计学意义（P〈0.05）,4级认知功能评分MoCA得分与3级相比较,除记忆、语言、注意外,视空间执行能力、定向力也差异有统计学意义（P〈0.05）,各级MoCA总分也差异有统计学意义（P〈0.05）。结论：注意力、延迟回忆可能是LA早期的特征性认知功能损害;脑白质疏松作为血管性认知功能障碍早期预测因子有一定的价值;LA分级与认知功能损害呈正相关,LA分级越高,认知功能损害无论在程度上还是广度上越严重。

Objective：To discuss the cognitive impairment of leukoaraiosis,and got to know the relationship between cognitive dysfunction and process of this disease,and estimated the value of leukoaraiosis to be an early predictor of vascular cognitive impairment.Methos： We selected 50 patients with leukoaraiosis group as A,by Aharon-Ptretz grading grading standards group,selected 50 patients with lacunar infarction as the B group,select 50 cases of head CT for the healthy elderly group C.All of the above used Montreal Cognitive Assessment to rate their cognitive function.Result： ①The MoCA scores between the three groups of A,B and C were different： except ＂naming＂score showed no significant differences between the C group and B group（P〉0.05）,MoCA score in these three groups and in each sub-group were significantly different（P〈0.05）.In particular,attention and delayed recall showed quite different in the A group and had a significant difference compared to B and C group（P〈0.01）.Moreover,The damage of time and place orientation were more obvious in the A group compared to the others.②Packet classification in the study of LA,0-1 grade had normal MoCA score;compared the 2 grade MoCA score to 0-1 grade,the other items had no statistical significance with 0-1 grade（P〉0.05） except for the significantly difference of memory scores（P〈0.05）;compared the 3 grade MoCA score to the 1 grade,memory,language and attention had significant difference（P〈0.05）and the rest of the items had no statistical significance（P〈0.05）;compared the 4 grade MoCA score to the 1 grade,there was significant difference in memory,language,attention,visual spatial implementation capacity and orientation（P〉0.05）;compared the 3 grade MoCA score to the 2 grade,memory,language and attention had significantly difference（P〈0.05）;compared the 4 grade MoCA score to the 3 grade,the visual space implementation capacity and orientation had significant difference include memory,language and attention（P〈0.05）.The overall MoCA scores at all levels had significant difference（P〈0.05）.Conclusion： Attention,delayed recall may be a characteristic of early LA cognitive impairment;there was some value of leukoaraiosis to be an early predictor of vascular cognitive impairment;LA classification study shows that,LA classification and cognitive function damage were correlated positively.It suggeated that with the higher classification of LA,the cognitive impairment was more serious in the extent.