皮质下缺血性脑血管病认知功能损害特点的临床研究

A Clinical Study on the Cognitive Impairment in Patients with Subcortical Ischemic Vascular Disease

目的:研究皮质下缺血性脑血管病(SIVD)患者认知功能损害的特点。方法:选择2011年7月?2012年9月就诊于哈尔滨医科大学第二附属医院门诊及住院患者,颅脑MRI影像学显示脑白质疏松患者49例为LA组,按照Abaron-peretz标准将LA组进一步分为4组;MRI表现为腔隙性脑梗死(LACI)患者为腔隙性脑梗死组,共30例;选择年龄、性别匹配的30例健康老年人为对照组。采用蒙特利尔认知评估量表(MoCA)对各组患者进行神经心理学测评,分析各组受损的认知领域。结果:1)LA各级别组间总体认知功能及延迟回忆比较差异显著(P<0.05);与1组、2组、3组比较,4组患者视空间/执行能力得分显著下降差异具有统计学意义(p<0.05)。2)与正常组相比LA组及LACI组患者总体认知评分降低;与LACI组比较,LA组延迟回忆评分以及视空间/执行、注意力评分均显著降低差异均具有统计学意义(P<0.05)。结论:SIVD患者同时存在多个认知域损害,以执行功能、视空间结构损害和注意力较为突出,同时存在记忆力损害。SIVD患者中腔隙性脑梗死患者视空间/执行能力及注意力损害为主,而LA患者则记忆力损害更为明显。

Objective：To analyze the characteristics of cognitive impairment in patients with subcortical ischemic vascular disease.Methods：In all the outpatients and hospitalized patients of the second Affiliated Hospital of the Harbin Medical University from July 2011 to September 2012,49 patients with leukoaraiosis were recruited for the LA group according to the results of MRI.The LA group was divided into 4 groups according to the Abaron-Peretz standard.30 cases with lacunar infarction according to MRI,15 age,sex matched cases as the normal group.The damaged cognitive domains in each group of the patients were assessed by the Montreal Cognitive Assessment Scale（MoCA）.Results：l）There were significant differences in cognitive function and delayed recall among the different LA levels groups（p 〈0.5）.Compared with patients in group 1,group 2 and group 3,the score of space ability in group 4 patients decreased significantly（p 〈0.5）.2） Comparing LA group and lacunar infarction group with the normal group,overall cognitive scores decreased statistically significant（p 〈0.05）.Compared with lacunar infarction group,the score of Delayed recall、space ability and attention in LA group was statistically significant（p 〈0.05）.Conclusions：Patients with SIVD existed multiple cognitive domains damage,especially executive function,visuospatial,attention and memory deficits.The main cognitive function damage of patients with lacunar infarction was visuospatial/executive ability and attention damage.The key cognitive function of patients with lacunar infarction was memory deficits.