老年人认知功能障碍与缺血性脑白质病变的相关性研究

Research on correlation between cognitive function impairment and ischemic cerebral white matter lesion in elderly people

目的探讨老年人认知功能障碍(CD)与缺血性脑白质病变的相关性及其危险因素,为老年人CD的预防提供依据。方法连续选取漯河市中心医院2014年7月至2015年8月门诊及住院的缺血性脑白质病变患者46例和对照老年人37例,登记受检者的年龄、性别、高血压病史、高脂血症病史、冠心病病史、糖尿病病史,统计分析其与脑白质病变的相关性。将脑白质病变者按脑白质病变部位分为皮层下组、室旁组和混合组,依据Wahlund提出的年龄相关白质改变分级方法,按照0~3分的四级标准对白质病变程度进行评分,采用简易精神状态检查量表(MMSE量表)进行神经心理学评估,比较不同部位及不同程度缺血性脑白质病变神经心理评估的差异。结果 (1)脑白质病变组与非脑白质病变组年龄、教育程度、性别构成、糖尿病、高脂血症、冠心病和初始神经功能评分比较,差异均无统计学意义(P>0.05)。脑白质病变组16例高血压者,非脑白质病变组5例高血压者。高血压发生率脑白质病变组较非脑白质病变组高,差异有统计学意义(P=0.027)。(2)脑白质病变组MMSE评分较非脑白质病变组低,差异有统计学意义(P=0.036)。缺血性脑白质病变皮质下组患者MMSE评分较室旁组低,差异有统计学意义(P=0.039)。(3)缺血性脑白质病变评分与MMSE评分呈线性相关。结论缺血性脑白质病变与认知功能损害存在相关性,高血压是其危险因素。皮层下脑白质病变者CD发生率较室旁组高,认知功能损害随着脑白质病变增多而加重。

Objective To investigate the correlation between the cognitive function impairment and the ischemic cerebral white matter lesion in elderly people and its risk factors to provide a basis for the prevention of elderly people cognitive function impairment. Methods Forty-six outpatients and inpatients with ischemic cerebral white matter lesions and 37 control elderly people in Luohe Municipal Central Hospital from July 2014 to August 2015 were continuously selected The age,gender,history of hypertension,hyperlipidemia,coronary heart disease and diabetes were registered and their correlation with cerebral white matter lesions was analyzed. The patients with cerebral white matter lesions were divided into the –grade of subcortical group,paraventricular group and mixed group according to the cerebral while matter pathological lesions. The white matter lesions were graded by four grade of 0-3 points according to the age-related white matter change classification methods proposed by Wahlund. Then the mini-mental state examination（MMSE）scale was adopted to conduct the neuropsychological assessment and then the differences in neuropsychological assessment were compared among different parts and different degrees of ischemic white matter lesions. Results（1）There were no statistically significant differences in ages,educational levels,gender composition,diabetes,hyperlipidemia,coronary heart disease and initial neurological scores between the white matter lesions group and non-white matter lesions group（P〉0.05）. There were 16 cases of hypertension in the white matter lesions group and 5 cases of hypertension in the non-white matter lesions group. The hypertension occurrence rate in the white matter lesions group was higher than that in the non-white matter lesions group,the difference was statistically significant（P=0.027）.（2）The MMSE score in the white matter lesions group was lower than that in the non-white matter lesions group,the difference was statistically significant（P=0.036）. The MMSE score in the subcortical group was lower than that in the paraventricular group,the difference showed statistically significance（P=0.039）.（3）The scores of ischemic cerebral white matter lesions showed the linear correlation with the MMSE score. Conclusion The ischemic cerebral white matter lesion is correlated with the cognitive function impairment,and hypertension is its risk factor. The occurrence rate of cognitive dysfunction in the patients with subcortical white matter lesions is higher than that in the patients with periventricular lesions. The cognitive function impairment is aggravated with cerebral white matter lesions increase.