血管性轻度认知功能障碍的临床特征分析

The clinical characteristics of vascular mild cognitive impairment

目的血管性轻度认知功能障碍(Va MCI)是指由血管性原因引起或相关的轻度认知损害综合征。文中探讨Va MCI患者认知功能损害的临床特征。方法收集2016年1月至同年6月期间于首都医科大学附属朝阳医院神经内科病房住院的75例Va MCI患者(Va MCI组)和38名年龄、性别、受教育程度相匹配的健康老年人(对照组)。采用神经心理学测验评价认知损害的严重程度,具体包括简易智力状态评定量表(MMSE)、蒙特利尔认知量表(Mo CA)、临床痴呆评定量表(CDR)、日常生活能力评定量表(ADL)、Hachinski缺血记分表、汉密尔顿抑郁量表(HAMD)以及听觉词语学习测试(AVLT)。采用Fazekas量表评价脑白质病变的严重程度,内侧颞叶萎缩评定量表(MTA)评价颞叶萎缩的严重程度。结果 Va MCI患者在总体认知功能评分[MMSE(25.7±2.3)分、Mo CA(22.8±3.9)分]显著低于对照组[MMSE(28.4±2.0)分、Mo CA(26.3±3.7)分],差异有统计学意义(P<0.05);AVLT-即刻回忆(5.1±1.0)、AVLT-延迟回忆(3.7±1.0)、AVLT-再认(7.6±1.9)评分显著低于对照组(P<0.05),提示Va MCI患者存在总体认知功能障碍,尤其是记忆损害;而Fazekas和MTA评分评分方面,Va MCI患者高于对照组,差异有统计学意义(P<0.05)。线性相关分析发现,Va MCI患者的MOCA评分与MTA评分负相关(r=-0.434,P=0.002)。结论 Va MCI患者存在明显的认知功能障碍,尤其是记忆功能损害,推测与脑白质病变和内侧颞叶萎缩的严重程度有关。

Objective Vascular mild cognitive impairment（ Va MCI） refers to mild cognitive impairment caused by or associated with vascular causes. This study aims to investigate the characteristics of the cognitive impairment in patients with vascular mild cognitive impairment（ Va MCI）. Methods Seventy-five patients with Va MCI（ Va MCI group） and 38 healthy old subjects whose age,sex and education level match the Va MCI group patients（ control group） were recruited from the department of Neurology,Beijing Chaoyang Hospital,Capital Medical University between Jan 2016 and June 2016. The neuropsychological examinations were used to evaluate the severity of cognitive impairment,specifically including the Minimum Mental State Examination（ MMSE）,Montreal cognitive assessment scale（ Mo CA）,Clinical Dementia Rating（ CDR）,Activity of Daily Living Scale（ ADL）,Hachinski ischemic score table,Hamilton Depression Scale（ HAMD） and Auditory Verbal Learning Test（ AVLT）. The Fazekas scale was used to assess the severity of white matter lesions,and the medial temporal lobe atrophy rating scale（ MTA） was used to evaluate the atrophic severity of medial temporal lobe. Results The overall cognitive function score in Va MCI group was significantly lower than the control group [MMSE[25.7±2.3 vs 28.4± 2.0] Mo CA [22.8± 3.9 vs 26.3± 3.7]],the differences was statistically significant（ P 〈 0. 05）; as well as the AVLT-I [5.1±1.0 vs 8.9±1.9],AVLT-D [3.7±1.0 vs 9.8± 1.5] and AVLT-R [7.6 ± 1. 9 vs 12 ± 1. 5] scores in Va MCI group was significantly lower than the control group,the differences was statistically significant（ P 〈 0. 05）,which suggested patients with Va MCI have overall cognitive impairment,especially memory impairment. But Fazekas and MTA scores in Va MCI groups were higher than the control group,the differences was statistically significant（ P〈0.05）. Correlation analysis showed that the scale of medial temporal lobe atrophy had a negative relationship with the performance of Mo CA（ r =-0.434,P = 0. 002）. Conclusion Our findings demonstrate patients with Va MCI have significant cognitive impairment,especially memory impairment,which may be correlated to the severity of the white matter lesions and the medial temporal lobe atrophy.