脑白质疏松症患者步态障碍与认知损害的关系

The relationship between gait disorders and cognitive impairments in patients with leukoaraiosis

目的探讨脑白质疏松症(LA)患者步态障碍的特点及其与认知的关系。方法选取42例LA患者作为LA组,另选择13例无LA正常老年人作为对照组(NC组),依据头颅MRI扫描结果,LA组按照Wahlund分级方法分为轻度(LA1)、中度(LA2)和重度(LA3)3组。对所有受试者进行神经心理学评估和步态测定。神经心理学评估采用简易精神状态检查量表(MMSE)和剑桥老年认知检查表-中国修订版(CAMCOG-C)。步态测定包括计时"起立-行走"测试(TUG)和P-WALK平板压力测试系统精确测量步长、步幅、步宽、步频、步速、单支撑相、双支撑相、步行周期等。比较LA组和NC组、LA各亚组与NC组间认知功能和步态参数,选取显著性差异指标进行相关及多元回归分析。结果 LA组患者MMSE评分及CAMCOG-C评分均显著低于NC组,差异有统计学意义(Z=-2.411,P=0.016;t=2.510,P=0.015);LA组患者较NC组TUG时间延长、步长、步幅缩短、步速减慢,差异均有统计学意义(Z=-3.269、-2.239、-2.219、-3.686,P=0.001、0.025、0.027、P<0.001)。LA各亚组与NC组比较:随LA程度增加,患者MMSE及CAMCOG-C评分降低,4组间差异有统计学意义(χ2=11.051、4.870,P=0.011、0.005);各步态参数中,随LA程度增加,患者TUG时间延长、步长、步幅缩短、步速降低、步宽增加与步频增快以LA3组较为明显,四组间差异有统计学意义(χ2=19.143、8.588、8.992、21.486、13.044、3.095,P<0.001、0.035、0.029、<0.001、0.005、0.035)。对LA患者进行相关性分析显示,TUG与MMSE、CAMCOG-C评分呈负相关性(r=-0.399、-0.404,P=0.003、0.002),并与CAMCOG-C子项中记忆和执行呈负相关(r=-0.321、-0.433,P=0.021、0.001)。步速与MMSE、CAMCOG-C评分呈正相关性(r=0.409、0.308,P=0.002),并与CAMCOG-C中执行功能呈正相关性(r=0.535,P<0.001)。校正LA等级分级后多元回归分析显示,步态参数与执行功能无相关性。结论 LA患者存在步态障碍,以步速降低最为显著;LA患者步态障碍与LA程度、认知功能损害有关。

Objective To explore the characteristics of gait disorders and its relationship with cognition impair- ments in patients with leukoaraiosis （ LA ）. Methods 42 patients with LA confirmed by MRI were chosen as LA group, and 13 normal elderly people without LA as the normal control group （NC）. According to the MRI scan ap- pearances, objects in LA group were graded into 3 subgroups as mild （ LA1 ）, moderate （ LA2）, severe （ LA3 ） by the rating scale of Wahlund. All of the 55 chosen objects accepted the neuropsychological assessment and the gait analysis. The mini-mental state examination（MMSE） and the Cambridge Cognitive Examination-Chinese Version （CAMCOG-C） were used in the neuropsychologieal assessment. Gait analysis contained the timed up and go test （TUG） and the P-WALK panel-pressure test system which can accurately measure the subjects＇ step length, stride length, stride width, step frequency, walking velocity, single support phase, double support phase, cycle time and so on. The cognitive function and the gait parameters between LA group and NC group, LA＇s subgroups and the NC group were compared, then the significant difference index was selected to do correlation and multiple regression a- nalysis. Results Compared to the NC, MMSE and CAMCOG scores were significantly lower in LA group （Z = -2. 411 ,P =0. 016;t =2. 510,P =0. 015）. In comparison with the NC, the LA group showed longer TUG, shor- ter step length and stride length, slower walking velocity, the differences were statistically significant （Z = - 3. 269, - 2. 239, - 2.219, - 3. 686, P = 0. 001,0. 025,0. 027,P 〈 0. 001 ）. Compared the subgroups of LA with the NC, MMSE and CAMCOG scores of LA patients were lower with the increasing of their LA degree, the differ- ence was statistically significant among the four groups（ χ2 = 11.051,4. 870, P = 0.011,0. 005 ）. In the gait param- eters, as the LA patients, the TUG of them were prolonged, the step length as well as the stride length were short- ened, the walking velocity became lower with the increasing of their LA degree. However, the stride width and the step frequency increased obviously in the LA3 group, the difference was statistically significant among the four groups（ χ2 = 19. 143,8. 588,8. 992,21. 486,13. 044,3. 095, P 〈 0. 001,0. 035,0. 029, 〈 0. 001,0. 005,0. 035 ）. According to the correlation analysis of LA patients , authors found that the TUG had a negative correlation with the MMSE and CAMCOG scores （ r = - 0. 399, - 0. 404, P = 0. 003,0. 002 ） , also with memory （ r = - 0. 321, P = 0. 021） and praxis scores（r = - 0. 433 ,P = 0. 001 ） in CAMCOG-C. Walking velocity had a positive correlation with the MMSE and CAMCOG scores （ r = 0. 409,0. 308 ; P = 0. 002 ） , also with praxis scores （ r = 0. 535, P 〈 0. 001） in CAMCOG-C. After adjusting the grade of LA, multiple regression analysis revealed that there was no correlation between gait parameters and cognition impairment. Conclusion There are gait disorders in patients with LA, and their low walking velocity is obvious ; the gait disorder of LA may be related to the grade of LA as well as the cognitive impairment.