脑白质病变患者不同程度分级与不同年龄组认知障碍临床特点的关系

The relationship between the severity of white matter lesions and clinical characteristics of cognitive impairment in different age groups

目的 探讨相同脑白质病变分级中,不同年龄组的认知障碍临床特点. 方法 连续入选2014年8月至201 7年3月于北京天坛医院神经内科（门诊及住院患者）的患者共110例,平均年龄（63.1土9.7）岁.年龄在65～85岁,平均年龄（71.6±5.2）岁为老年组;年龄在50～64岁,平均（54.8±3.4）岁为中年组.同时采用Fazekas视觉评分量表对110例患者的白质病变严重程度进行分级.运用采用蒙特利尔认知量表（MoCA）对患者的认知功能进行评价.对老年组与中年组在MoCA总分及各认知域方面进行比较. 结果 老年组与中年组比较,Fazekas1级：MoCA总分（老年组：25.5±2.2）及（中年组：28.1±1.4）（t=6.946,P=0.000）、视空间与执行能力（老年组：3.8±0.9）及（中年组：4.5±0.6）（t=3.726,P=0.023）、延迟记忆力（老年组：2.7±1.5）及（中年组：4.0土1.0）（t=4.365,P=0.018）方面差异有统计学意义（均P＜0.05）.Fazekas2级：MoCA总分（老年组：22.5±2.5）及（中年组：24.1±1.5）（t=3.361,P=0.034）、视空间与执行能力（老年组：2.8±1.2）及（中年组：3.8±0.8）（￡=6.473,P=0.007）、注意力（老年组：4.6±1.3）及（中年组：5.6土0.5）（t=0.491,P=0.721）方面差异有统计学意义（P＜0.05）.Fazekas3级：MoCA总分（老年组：15.2±3.4）及（中年组：19.4±2.8）（t=4.709,P=0.001）、视空间与执行能力（老年组：1.8±1.1）及（中年组：2.8±1.4）（￡=1.563,P=0.043）、注意力（老年组：3.3±1.1）及（中年组：4.4±1.4）（t=2.231,P=0.026）及定向力（老年组：4.2±1.3）及（中年组：5.7±0.5）（t=3.255,P=0.000）方面较中年组明显降低（P＜0.05）. 结论 脑白质病变可增加血管性认知障碍的风险,在中年组和老年组均可引起多个认知功能下降.老年人伴有脑白质病变认知功能障碍,主要体现在视空间与执行能力方面.

Objective To explore the clinical characteristics of cognitive impairment in different age groups with the same severity of white matter lesions.Methods This study involved 110 consecutively recruited patients with white matter lesions（WMLs）from the Department of Neurology at Beijing Tiantan Hospital from August 2014 to March 2017.Patients were aged from 50 to 85 with a mean age of 63.1±9.7,and they were divided into an elderly group with a mean age of 71.6±5.2 （range：65-85 years）and a middle aged group with a mean age of 54.8 ± 3.4 （range：50-60 years）.The severity of white matter lesions was evaluated with the Fazekas scale.MoCA was used to evaluate the cognitive function of patients.Results For Fazekas 1,the MoCA score was 25.5 ± 2.2 in the elderly group and 28.1 ± 1.4 in the middle aged group（t =6.946,P =0.000）;the score for visuospatial and execution abilities was 3.8 ± 0.9 in the elderly group and 4.5 ± 0.6 in the middle aged group（t =3.7 2 6,P =0.0 2 3）;the score for delayed memory was 2.7 ± 1.5 in the elderly group and 4.0 ± 1.0 in the middle aged group（t =4.365,P =0.018）.For Fazekas 2,the MoCA score was 22.5±2.5 in the elderly group and 24.1 ± 1.5 in the middle aged group（t =3.361,P =0.034）;the score for visuospatial and execution abilities was 2.8 ± 1.2 in the elderly group and 3.8 ± 0.8 in the middle aged group（t=6.473,P=0.007）;the score for concentration was 4.6± 1.3 in the elderly group and 5.6±0.5 in the middle aged group（t=0.491,P=0.721）.For Fazekas 3：the MoCA score was 15.2 ± 3.4 in the elderly group and 19.4 ± 2.8 in the middle aged group（t =4.709,P =0.001）;the score for visuospatial and execution abilities was 1.8 ± 1.1 in the elderly group and 2.8± 1.4 in the middle aged group（t =1.563,P =0.043）;the score for concentration was 3.3± 1.1 in the elderly group and 4.4± 1.4 in the middle aged group（t=2.231,P=0.026）;the score for orientation was 4.2 ± 1.3 in the elderly group and 5.7 ± 0.5 in the middle aged group （t=3.255,P =0.000）.Conclusions WMLs can increase the risk of vascular cognitive impairment and cause decline in multiple cognitive functions in both middle aged and elderly people.Cognitive dysfunction in age-related WMLs is mainly characterized by impairment in visuospatial and execution abilities.