孤立性侧脑室后角旁白质疏松对认知功能的影响及其神经心理特征

Neuropsychological characteristics of cognitive impairments associated with occipital periventricular leukoaraiosis

目的探讨孤立性侧脑室后角旁白质疏松对认知功能的影响及其神经心理特征。方法纳入30例孤立性侧脑室后角旁白质疏松(后角组)、32例大脑半球多部位白质疏松(混合组)以及33例颅脑MRI证实无脑实质结构性改变的受试者(对照组),采用简易精神状态量表(mini-mental state examination scale,MMSE)和蒙特利尔认知评估量表(Montreal cognitive assessment,Mo CA,北京版),评价受试者总体认知功能,韦氏成人智力量表中数字广度测验分项目评估注意能力,临床记忆量表评估记忆能力,对比分析侧脑室后角旁白质疏松所致认知损害特征。结果与对照组比较,后角组MMSE和Mo CA总分较低(P<0.01),定向力、短时记忆、延迟记忆、指向记忆和语言测试单项评分也明显降低(P<0.05,P<0.01),而其他认知方面单项评分差异无统计学意义(P>0.05);混合组MMSE和Mo CA总分较低(P<0.01),定向力、记忆力、注意能力、视觉空间与执行、语言测试和抽象认知单项评分也明显降低(P<0.05,P<0.01)。结论孤立性侧脑室后角旁白质疏松导致以定向力、记忆力和语言能力减退为特征的认知功能损害。

Objective To explore the effect of isolated occipital periventricular leukoaraiosis on cognitive function and the aeuropsychological characteristics of the patients. Methods Thirty patients with isolated occipital periventricular leukoaraiosis （occipital periventricular group）, 32 patients with leukoaraiosis at multiple sites in the cerebral hemisphere （mixed group） and 33 subjects without structural changes in the brain parenchyma as confirmed by craniocerebral magnetic resonance （control group） were included in this study. The mini-mental state examination scale （MMSE） and the Montreal cognitive assessment （MoCA, Beijing） were used to evaluate the global cognitive function of the subjects. The digital span test （a subentry of the Wechsler adult intelligence scale） and the clinical memory scale were used to evaluate the attention and memory abilities of the subjects, respectively. The characteristics of cognitive impairment caused by occipital periventricular leukoaraiosis were analyzed in the patients. Results Compared with the control group, the patients with occipital periventricular leukoaraiosis had significantly lower average total scores of MMSE and MoCA （P 〈 0.01 ） with also lower scores in the subentries including orientation, short-term memory, delayed memory directed memory and language tests （ P 〈 0. 01, 0.05 ） ; the scores of the other subentries were comparable between the 2 groups （ P 〉 0. 05 ）. The patients in the mixed group had significantly lower average total scores of MMSE and MoCA （ P 〈 0. 01 ） and lower scores for orientation, memory, attention, visual spatial and execution, and language abilities as well as for abstract cognition than the control group （P 〈0.01,0.05）. Conclusion Isolated occipital periventricular leukoaraiosis causes cognitive impairments characterized by orientation, memory and language incompetence.