具有痴呆倾向的老年轻度认知障碍患者神经心理学特点

Neuropsychological features of elderly patients with mild cognitive impairment susceptible toAlzheimer＇s disease

目的探讨具有痴呆倾向的老年轻度认知障碍（MCI）患者特征性的神经心理学变化。方法以2008年6至10月某驻京部队干休所47例确诊MCI患者及21名认知功能正常者为研究对象，随访2年，应用蒙特利尔认知评估表（MoCA）中文版、简易精神状态量表（MMSE）和画钟表测验（CDT）评估认知状况。结果第一年随访，MCI组视空间得分下降程度较对照组（0．6±0．7比0．1±0．6）显著，差异有统计学意义（P=0．008），两组均无进展为AD者。第二年随访，MCI组与对照组比较视空间（0．94±0．9比0．4．4±0．9）及注意（1．0±1．0比0．2±0．8）得分下降程度差异有统计学意义（P=0．021；0．001），MCI组中7例发生AD，对照组无发生AD者。7例发生AD者与40例未发生AD者基线认知评估得分差异无统计学意义；第一年随访时与未发生AD者比较，发生AD者MMSE（27．6±0．8比28．9±1．0）、MoCA（24．34±3．1比27．9±1．6）、视空间（3．9±0．7比4．5±0．6）、语言（1．86±0．38比2．65±0．53）及延迟回忆（2．1±1．5比3．9±1．0）得分显著下降，差异均有统计学意义（均P〈0．05）；第二年随访时，除命名和抽象得分外，发生AD者其他项目得分均明显低于未发生AD者，差异均有统计学意义（均P〈0．05）。结论具有痴呆倾向的MCI患者视空间、执行功能，延迟回忆和语言功能的受损出现早，变化显著，对AD的发生具有预测意义。

Objective To explore the neuropsychological features of elderly patients with mild cognitive impairment （MCI） susceptible to Alzheimer＇s disease （AD）. Methods A total of 47 patients with MCI diagnosed from June to October 2008 and 21 controls with normal cognition at the same convalescent camp were selected and followed up for two years. Montreal cognitive assessment （ MoCA）, mini mental state examination （MMSE） and clock drawing test （CDT） were performed for all subjects at the onset of study and repeated annually. Results At Month 12, the visuospatial skill scores of MCI patients decreased significantly versus those of the control （0. 6 ± 0. 7 vs 0. 1 ± 0. 6, P = 0. 008 ）. No one progressed to AD in neither groups. And at Month 24, both visuospatial skill scores （0. 9 ± 0. 9 vs 0.4 ± 0. 9 ）and attention scores （ 1.0 ± 1.0 vs 0. 2 ± 0. 8） of MCI patients declined significantly versus the control （P =0. 021, 0. 001 ）. Among 47 MCI patients, 7 progressed to AD. No obvious difference existed in the score of all items between the AD converters and non-converters at baseline. However, the scores of MMSE （ 27.6 ± 0. 8 vs 28.9 ± 1.0）, MoCA（24. 3 ±3.1 vs 27. 9 ± 1.6）and such MoCA subitems as visuospatial skill（3.9±0. 7 vs 4. 5 ± 0. 6）, language （ 1.86 ± 0. 38 vs 2. 65 ± 0. 53 ） and delayed recall （ 2. 1 ± 1.5 vs 3.9± 1.0） of the converters were obviously lower than those of the non-converters at Month 12 （ P 〈0. 05 ）. Furthermore, all other scores of the AD converters, except for designation and abstract, were significantly lower than those of the non- converters at Month 24 （ P 〈 0. 05 ）. Conclusion The visuospatial skill, executive function, delayed recall and language function of MCI patients progressing to AD tend to have early impairment and significant changes. It may be useful to predict AD among the MCI patients.