摘要
目的探讨不同类型脑白质疏松症(LA)患者轻度认知功能障碍(MCI)认知域损害特点。方法LA患者256例,根据MCI诊断标准筛选出MCI患者181例,按入院时头颅磁共振成像(MRI)的脑白质疏松部位分为三组:脑室周围型(第一组)72例、皮质下型(第二组)56例、混合型(第三组)53例。分析比较三组认知域损害类型、Mo CA量表检测比较认知损害内容。结果 1LA患者MCI检出情况:256例LA患者进入MCI筛查,有181例诊断为MCI(70.70%);其中脑室周围型LA 72例(39.78%),皮质下型56例(30.94%),混合型53例(29.28%),三组比较差异无统计学意义;2三组MCI认知域损害类型比较:第一组以遗忘型单认知域损害MCI(a MCI-s)型、遗忘型多认知域损害MCI(a MCI-m)型为主(51.40%、25.00%);与非遗忘型单认知域损害MCI(na MCI-s)型(13.88%)、非遗忘型多认知域损害MCI(na MCI-m)型(9.72%)比较差异有统计学意义(p<0.01);且a MCI-s与a MCI-m比较,p<0.01。第二组以a MCI-m及a MCI-s较多见(42.86%、30.35%),与na MCI-s(8.93%)、na MCI-m(17.86%)比较,p<0.01;且a MCI-m与a MCI-s比较,p<0.05;第三组以a MCI-m及a MCI-s较多见(52.83%、26.41%),与na MCI-s(7.55%)、na MCI-m(13.21%)比较,p<0.01;且a MCI-m与a MCI-s比较,p<0.05;3三组Mo CA量表检测认知损害内容比较:三组在延迟记忆项得分最低:1.39±1.42、1.44±1.06、1.51±1.32,但组间比较差异无统计学意义;第二、三组Mo CA总分分别为20.43±3.01、20.66±3.14,较第一组21.52±2.68明显降低(p<0.05);其中抽象功能项第二、三组分别为0.58±0.56、0.59±0.51,较第一组(0.78±0.67)降低最显著(p<0.01);视空间与执行功能项第二、三组分别为2.92±0.92、3.04±1.03,较第一组(3.71±0.75)亦有降低(p<0.05);第二、三组认知损害内容比较,P>0.05。结论三种类型LA与MCI存在相似的相关性,提示对于任何一种LA均需严密筛查、预防MCI的发生、发展;不同类型LA所致MCI的认知损害类型各有特点:脑室周围型以a MCI-s最多,记忆障碍为其主要表现,皮质下型、混合型LA更多表现为a MCI-m,即包括记忆障碍在内的多个认知功能损害;在MCI认知损害内容方面,延迟记忆障碍是各型LA相关性MCI最显著的共同特点;皮质下型、混合型LA对认知功能的影响更显著,尤其在抽象功能方面,视空间与执行功能也存在一定影响。认识这样的差异有助于早期识别LA相关MCI、有针对性地选择干预方式,以规范LA的二级预防。
ObjectiveToexplorethecognitivedomaincharacteristicsofmildcognitiveimpairment(MCI) indifferenttypesofleukoaraiosis(LA).Methods 256patientswithLA,181patientswithMCIwereselected according to the diagnosis of MCI .LA was divided into three groups according leukoaraiosis parts in magnetic resonance imaging ( MRI) 72 cases were circumventricular type ( group 1) , 56 cases were subcortex type ( group 2) , 53 cases were mixed type ( group 3) .Analysis the damage characteristics of MCI among three groups , and cognitive impairmentcontentwastestedbyMoCAscale.Results ①LApatientswithMCIdetection:256patientswithLAinto MCI screening, 181 cases were diagnosed as MCI (70.70%);There were 72(39.78%) subjects in group I and 56 (30.94%) subjects were in group 2, 74(29.28%) cases were in group 3, there was no statistical difference among three groups;② MCI cognitive domain damage type comparison in three groups : In group 1, there was amnestic MCI-single domain (aMCI-s), amnestic MCI-multiple domain (aMCI-m) mainly(51.40%, 25.00%,which compared with nonamnestic MCI-single domain ( naMCI-s ) ( 13.88%) and nonamnestic MCI-multiple domain ( naMCI-m ) (9.72%), the difference was significantly (p〈0.01);and there were statistical significance between aMCI-s and aMCI-m was (p〈0.01).In group 2 , aMCI-m was 42.86%and aMCI-s was 30.35%,which compared with naMCI-s ( 8.93%) and naMCI-m ( 17.86%) ,P〈0.01;and then compare aMCI-m with aMCI-s, p〈0.05.In group 3, aMCI-m and aMCI-s were 52.83%and 26.41%, which compared with naMCI-s (7.55%) and naMCI-m (13.21%) ,p〈0.01;and compare aMCI-m with aMCI-s, p〈0.05; ③ MoCA content scale detecting cognitive impairment comparison in three groups:three groups scored lowest on delayed memory:1.39±1.42, 1.44±1.06、1.51±1.32, but there was no statistical difference among groups ;the MoCA scores were 20.43±3.01 in group 2 and 20.66±3.14 in group 3 which were significantly decreased than group 1(21.52±2.68,p〈0.05);The abstract function item in group 2,3 were 0.58± 0.56,0.59±0.51 respectively, which were significantly decreased than group 1(0.78±0.67,p〈0.01).The visual space and executive function item in group 2,3 were2.92±0.92、3.04 ±1.03 respectively, which were decreased than group 1 (3.71±0.75 ,p〈0.05).There was no significant difference about cognitive impairment between group 2 and group 3 ( p〈0.05) .Conclusion There were similar correlation to MCI in three types of LA .So it suggested that it was necessary to strictly screening any kind of LA to prevent the occurrence and development of MCI .Different characteristics of MCI caused by different types of LA:circumventricular type with aMCI-s mostly, memory disorders as its main performance; subcortex type , mixed type LA were more performance as aMCI-m, multiple cognitive functions as its main performance , including memory impairment .In terms of content of the MCI cognitive impairment , delayed memory impairment is common characteristic of the MCI in each LA .Subcortex type , mixed type LA impact cognitive function significantly , especially in terms of abstract function , and visual space and executive function also has certain influence .Understanding such differences is helpful to early identification MCI in LA and selected a targeted intervention , to regulate LA secondary prevention .
出处
《脑与神经疾病杂志》
2015年第3期217-221,共5页
Journal of Brain and Nervous Diseases
基金
上海市浦东新区科技发展基金创新资金(PKJ2012-Y17)
上海市浦东新区人民医院重点学科群建设项目(PRxkq2013-01)