不同病因轻度认知功能障碍患者早期特征鉴别

Identification of the early risk factors in mild cognitive impairment patients with different etiology

目的探讨皮质下小血管病源性轻度认知障碍(MCI-SVD)和Alzheimer's病源性轻度认知障碍(MCI-AD)患者的血管危险因素、脑动脉粥样硬化和脑解剖结构的特征。方法收集48例MCI-SVD患者、40例MCI-AD患者和59名老年对照者的临床资料。采用临床痴呆评定量表(CDR)和蒙特利尔认知评估(MoCA)中文版对患者进行认知功能评估。于入院后采用彩色多普勒超声对患者进行检查,记录左侧及右侧颈内动脉内膜厚度、斑块积分(Crouse积分)以及颈内动脉末段、大脑中动脉、大脑前动脉、大脑后动脉、椎动脉、基底动脉(BA)的平均血管搏动指数(MPI)。同时采用线性测量方法采集患者头颅MRI的脑解剖结构数据。结果与对照组比较,MCI-AD组、MCI-SVD组高血压、糖尿病、吸烟的比率显著升高,Mo CA评分显著降低;MCIAD组低密度脂蛋白胆固醇、载脂蛋白B水平显著降低(P<0.05~0.01)。MCI-AD组和MCI-SVD组各血管危险因素差异均无统计学意义(均P>0.05)。与对照组比较,MCI-AD组患者视空间和执行功能、注意、计算、抽象、延迟回忆、画钟评分均显著降低(P<0.05~0.01);MCI-SVD组视空间和执行功能,注意、计算、抽象、延迟回忆、画钟、定向均显著降低(均P<0.01)。MCI-AD组视力空间和执行功能评分显著高于MCI-SVD组(P<0.05)。与对照组比较,MCI-SVD组Crouse积分和BA MPI显著增高(均P<0.05)。与对照组比较,MCIAD组患者最宽脑沟值、海马沟回比及MCI-SVD组第三脑室和尾状核指数显著升高(均P<0.01)。MCI-AD组最宽脑沟值显著高于MCI-SVD组(P<0.05)。结论 MCI-AD和MCI-SVD均表现为多领域认知功能的减退。MCI-AD患者皮质和海马显著萎缩,反映了记忆相关的海马-内侧颞叶功能通路破坏;MCI-SVD患者皮质下萎缩,可能由于额叶-皮质下环路的破坏导致认知障碍。两者比较,MCI-SVD患者执行功能损害更显著,而MCI-AD患者皮质萎缩更显著。

Objective To investigate the features of mild cognitive impairment due to subcortical small vessel disease（ MCI-SVD） and Alzheimer＇s disease（ MCI-AD） in vascular risk factors,atherosclerosis and cerebral anatomy. Methods The clinical data of 48 cases of MCI-SVD patients,40 cases of MCI-AD patients and 59 elderly controls were collected. Cognitive function was evaluated by clinical dementia rating（ CDR） and Montreal cognitive assessment（ Mo CA） Chinese version. After admission,the left side internal carotid artery（ LCCA） and right side internal carotid artery（ RCCA） intima-media thickness（ IMT） and plaque score（ Crouse score）,the last paragraph of the internal carotid artery,middle cerebral artery,anterior cerebral artery,posterior cerebral artery,vertebral artery,basilar artery（ BA） mean pulsatility index（ MPI） were recorded by color Doppler ultrasound. Meanwhile,the brain anatomical data of the patients with MRI were collected by linear measurement method. Results Compared with control group,the ratio of hypertension,diabetes and smoking in MCI-AD group and MCI-AD group were significantly increased, Mo CA scores were significantly decreased; and low density lipoprotein cholesterol,apolipoprotein B in MCI-AD group were significantly decreased（ P 0. 05-0. 01）. There was no significant difference of vascular risks between the MCI-AD group and the MCI-SVD group（ all P 0. 05）. Compared with the control group,the scores of visuospatial and executive function,attention,calculation,abstract,delayed recall,clock drawing in MCI-AD group were significant lower（ P 0. 05-0. 01）,the ability of visuospatial and executive function,attention, calculation, abstract, delayed recall, clock drawing and orientation in MCI-SVD group significantly decreased（ all P 0. 01）. The scores of visual spatial and executive function in MCI-AD group were significantly higher than those in group MCI-SVD（ P 0. 05）. Compared with control group,the Crouse score and the MPI of BA in MCI-SVD group were significantly higher（ all P 0. 05）. Compared with the control group,MCI-ADgroup have significantly increased in widest sulcus,hippocampal sulcus ratio（ all P 0. 01）,and MCI-SVD group increased in the third ventricle and the caudate nucleus index（ P 0. 01）. The widest sulcus in MCI-AD group was significantly higher than that in MCI-SVD group（ P 0. 05）. Conclusions Both MCI-AD and MCI-SVD show damage in multiple areas of cognition. MCI-AD patients manifest cortical and hippocampal atrophy which reflects memory related hippocampal medial temporal lobe function pathway damage. MCI-SVD patients showed subcortical atrophy,possibly through the frontal subcortical circuits damage caused cognitive dysfunction. Compared between the two diseases,MCI-SVD patients show more damage on executive function,and cortical atrophy is more significant in MCI-AD patients.