脑白质疏松症患者认知功能损害的特点及其静息态功能磁共振观察

Characteristics of cognitive impairment and the resting state functional MRI in patients withleukoaraiosis

目的应用神经心理学量表和静息态功能磁共振成像（rs-fMRI）检查，探索脑白质疏松症（LA）所致认知障碍的特点及其可能的病理生理学机制。方法收集2016年1月至2016年6月在山西省人民医院就诊或收治的13例LA患者（LA组）及与之年龄、性别、教育程度相匹配的健康老年对照者13名（NC组），进行神经心理学测评及rs-fMRI扫描，比较两组量表评分差异及脑静息态神经元活动有显著差异的脑区，并将神经心理学评分与这些脑区的低频振幅（ALFF）值进行相关分析。结果LA组MMSE[（23.3±10.7）分比（29.7±0.6）分，P〈0.05]、MoCA评分[（22.7±10.7）分比（29.5±0.7）分，P〈0.05]低于NC组；两组在Stroop色词干扰测验[（127±72）分比（48±12）分]、DS[（4.2±2.2）分比（6.2±0.9）分]、词语相似性测验[（16.5±8.1）分比（23.1±2.5）分]、即刻记忆[（6.1±3.5）分比（11.0±2.2）分]、延迟回忆[（4.7±2.8）分比（11.0±2.4）分]、TMT-A[（168±136）分比（47±10）分]结果比较差异均有统计学意义（均P〈0.05）；LA组ALFF显著降低的脑区有右侧后扣带回、右侧楔前叶、楔叶、右侧中央后回/中央前回、右侧矩状裂及周围皮质（均P〈0.05）；相关性分析发现，去除年龄、性别、教育的影响后，与认知功能减退相关的脑区有右侧后扣带回、右侧楔前叶、楔叶、右侧中央后回等。结论LA患者整体认知功能降低，以执行功能、记忆力、注意力、信息加工处理速度受损为主，LA患者认知功能减退与多个脑区自发活动异常有关，尤其是右侧后扣带回、右侧楔前叶、楔叶等部位。

ObjectiveTo investigate the features of cognitive impairment and potential physiopathologic mechanism using neuropsychological assessment and resting state functional magnetic resonance imaging （rs-fMRI） in patients with leukoaraiosis （LA）. MethodsA total of 13 patients with LA （LA group） and 13 healthy controls （NC group） from Shanxi Provincial People′s Hospital between January and June 2016 were recruited. The two groups were matched for age, sex, education, and vascular risk factors. All the subjects underwent neuropsychological assessment and the scan of rs-fMRI. The neuropsychological scores and the brain areas had significant differences of cerebral spontaneous activity in resting state of the two groups were compared, and the relationship between the scores and the amplitude of low frequency fluctuation （ALFF） were evaluated in these areas.ResultsLA group was associated with comprehensive cognitive impairment, including minimum mental state examination （MMSE） （LA group： 23.3±10.7 vs NC group： 29.7±0.6）, montreal cognitive assessment （MoCA） （22.7±10.7 vs 29.5±0.7）, digit span test （DS） forwards （6.5±3.2 vs 8.7±1.1） and backwards （4.2±2.2 vs 6.2±0.9）, trail making test （TMT） part A （168±136 vs 47±10）, immediate memory （6.1±3.5 vs 11.0±2.2） and delayed memory （4.7±2.8 vs 11.0±2.4） of auditory verbal learning test （AVLT）, Stroop B （60±34 vs 32±7） and C （127±72 vs 48±12）, verbal similarity test （16.5±8.1 vs 23.1±2.5） （all P〈0.05）. Compared with the NC group, patients with LA showed decreased ALFF in areas of the right posterior cingulate cortex （PCC）, precuneus_R, cuneus, postcentral_R, precentral_R, calcarine_R （all P〈0.05）. After adjustment for the influences of age, sex and education, the correlation analysis showed that right PCC, precuneus_R, cuneus, postcentral_R, etc, were closely related with cognitive impairment.ConclusionsPatients with LA exhibits significant cognitive impairment, such as executive function, memory, attention and information processing speed. And cognitive impairment of LA is related to abnormal cerebral spontaneous activity, especially in areas of right PCC, precuneus_R, cuneus, etc.