血管性认知障碍非痴呆患者的神经心理学特征及相关影响因素

Neuropsychological characteristics of patients with vascular cognitive impairment no dementia and its related influencing factors

目的 探讨血管性认知障碍非痴呆（VCIND）患者发病的相关因素及其简易精神状态（MMSE）量表和蒙特利尔认知评估（Mo CA）量表的神经心理学特征。方法 收集山西医科大学第一医院神经内科2013年3月至2014年10月VCIND住院患者70例为试验组（VCIND组）;同时选择同一时间段到本院体检的,与VCIND组患者年龄和性别匹配的健康人群共70例为正常对照组（NC组）。收集相关临床资料,并进行MMSE、Mo CA量表评估。结果 （1）由单因素分析可知,饮酒、文化程度、高血压、糖尿病、心脏病、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、同型半胱氨酸（HCY）和C反应蛋白与VCIND相关（t/χ^2值分别为33.466、16.579、25.905、26.937、5.029、2.023、2.316、6.310、4.595,均P〈0.05）。（2）多因素Logistic回归分析显示,该病的影响因素为饮酒、文化程度、高血压、糖尿病、HCY,其中文化程度较高为保护因素,其他为危险因素（OR值分别为13.042、0.315、8.277、12.704、1.194,均P〈0.05）。（3）VCIND组在言语表达、图形描述方面分值低于NC组,差异有统计学意义（t值分别为-6.36、-6.80,均P〈0.05）。（4）VCIND组在视空间和执行功能、抽象思维方面分值低于NC组,差异有统计学意义（t值分别为-9.18、-2.96,均P〈0.05）。结论 VCIND发病与多种因素有关,包括饮酒、文化程度、高血压、糖尿病、HCY,文化程度为其保护因素,其他的为危险因素。VCIND患者均存在不同程度的认知领域的损害,尤以言语表达、图形描述、视空间和执行功能、抽象思维损害为主。

Objective To discuss the related factors and neuropsychological characteristics in minimental state examination （MMSE） and montreal cognitive assessment （MoCA） of vascular cognitive impairment no dementia （VCIND）. Methods Seventy hospitalized patients with VCIND from the Department of Neurology in the First Hospital of Shanxi Medical University from March 2013 to October 2014 were chose as study group（VCIND group）. At the same time,a total of 70 healthy people whose ages and gender matched with VCIND group were chose as normal control group （ NC group）. The clinical data of patients were collected by the form designed for this subject. We evaluated the patients by MMSE and MoCA scales. Results （ 1 ） By single factor analysis, there were statistically difference in alcohol abuse, cultural degree, blood pressure, diabetes, heart disease, TC, LDL, HCY and elevated C-reactive protein levels between the two groups （ t/χ^2 values were 33. 466,16. 579,25.905,26. 937,5. 029,2. 023,2. 316,6. 310,4. 595, respectively, all P 〈 0. 05）. （2） By multiariable Logistic regression analysis, the influence factors of VCIND were alcohol abuse, cultural degree, high blood pressure, diabetes, high HCY. The higher cultural degree was the protective factor. Others were risk factors （ OR values were 13. 042,0. 315, 8. 277, 12. 704, 1. 194, respectively, all P 〈 0.05 ）. （ 3 ） The scores of verbal exposition and the graph description of VCIND group were lower than NC group in the MMSE scale, the difference was statistically significant （t values were - 6. 36, - 6. 80, respectively, all P 〈 0. 05 ）. （ 4 ） The scores of covering space and executive function, abstract thinking of VCIND group were lower than NC group in the MoCA scale, the difference was statistically significant（t values were -9. 18, -2. 96,respectively,all P 〈0.05）. Conclusion There is a different degree of damage in the field of cognition, in particular in the verbal exposition, graph description, visual space and cover/ng space, executive function, abstract thinking.