老年人脑白质改变的危险因素及其与认知功能障碍的相关性研究

Risk Factors for White Matter Changes and Their Correlation with the Cognitive Impairment in Elderly People

目的探讨老年人(≥75岁)脑白质改变(WMC)发生的危险因素及其与认知功能障碍的相关性。方法根据影像学改变选择WMC患者76例(WMC组)和无WMC者74例(对照组)为研究对象。对WMC组进行影像学Fazekas视觉等级评分,根据评分将WMC分为轻度、中度和重度。采用Logistic法分析WMC发生的危险因素。应用神经心理学量表评估分析WMC对认知功能的影响。结果与对照组比较,WMC组的年龄、高血压病、糖尿病、纤维蛋白原水平差异有显著统计学意义(分别P=0.003、P<0.001、P=0.006、P<0.001)。Logistic分析发现年龄、高血压病、纤维蛋白原水平是WMC的独立危险因素。WMC组的简明精神状态检查、蒙特利尔认知评估、画钟试验、6项躯体性日常生活能力、8项工具性日常生活能力等认知功能量表检测均差异有显著统计学意义(均P<0.001),在校正年龄等因素后仍存在差异。结论年龄、高血压病、糖尿病、纤维蛋白原水平与老年人WMC有关,年龄、高血压病、纤维蛋白原水平升高是WMC的独立危险因素。中、重度WMC可引起≥75岁老年人认知功能和日常生活能力下降。

Aim To study the risk factors for white matter changes （WMC） and their correlation with WMC and cognitive impairment in elderly people. Methods According to the imageological change, 150 subjects were divided them into two groups, a WMC group （76 cases） and a control group （74 cases）. The WMC group were assessed with visual rating of Fazekas according to MRI and were divided into 3 subgroups （mild group, moderate group and severe group）. The risk factors for WMC were analyzed with Logistic method. The effects of white matter changes on cognitive function of all the subjects was evaluated with neuropsychological assessment. Results There were signiifcantly differences on age, hypertension, diabetes mellitus and ifbrinogen level between the WMC group and the control group （P=0.003,P﹤0.001, P=0.006 and P〈0.001 respectively）. At multiple regression analysis, age, hypertension, and ifbrinogen level were the independent risk factors for WMC. There were signiifcant differences on mean MMSE score, mean MoCA score, mean CDT score, mean BADL score , and mean IADL score （P﹤0.001） between the WMC group and the control group. After these factors were adjusted, there were still differences. Conclusion Age, hypertension, and ifbrinogen level were the independent risk factors for WMC in elderly people. WMC of moderate and severe degree may affect cognition and daily life ability of elderly people.