不同类型脑小血管病患者认知功能障碍特征及危险因素分析

Analysis of cognitive dysfunction and risk factors in patients with different types of cerebral small vessel disease

目的探讨不同类型脑小血管病患者认知功能障碍特征及其危险因素.方法对180例脑小血管病患者采用中文版蒙特利尔认知评估量表、简易智力状态量表、日常生活能力量表、严重障碍量表评估认知功能状况,将有认知功能障碍患者中依据不同病变部位进行分组,对比分析蒙特利尔认知评估量表评分结果,并对患者发生认知功能损害进行多因素Logistic回归分析.结果180例患者各量表评分均处于较低水平,有认知功能障碍114例(63.33%).蒙特利尔认知评估量表评分有认知功能障碍腔隙性脑梗死患者的基底节组语言能力得分显著低于丘脑组、皮层或皮层下组和额叶组(P<0.05);额叶组延迟回忆得分显著低于基底节组、丘脑组和皮层或皮层下组(P<0.05);基底节组和额叶组执行能力得分显著高于丘脑组和皮层或皮层下组(P<0.05);基底节组总分显著低于丘脑组和皮层或皮层下组(P<0.05).白质病变患者中,侧脑室旁组注意力得分显著低于皮质下病变组、侧脑室前角组和侧脑室后角组(P<0.05);侧脑室前角组延迟回忆得分显著低于皮质下病变组、侧脑室后角组和侧脑室旁组(P<0.05);皮质下病变组执行能力得分明显低于侧脑室前角组、侧脑室后角组和侧脑室旁组(P<0.05);侧脑室前角组执行能力得分显著低于侧脑室后角组和侧脑室旁组(P<0.05).受教育年限是预防患者发生认知功能损害的保护因素(P<0.01),高龄、糖尿病、高脂血症是患者发生认知功能损害的独立危险因素(P<0.05或0.01).结论不同类型脑小血管病患者中,不同病变部位患者其认知功能障碍特征有所不同;高龄、糖尿病、高脂血症是脑小血管病患者发生认知功能障碍的危险因素.

Objective To investigate the cognitive dysfunction and risk factors in patients with different types of cerebral small vessel disease.Methods The cognitive function status in 180 patients with cerebral small vessel disease was evaluated using MoCA,MMSE,ADL,and SIB.Patients with cognitive dysfunction were grouped according to different lesions.The MoCA score results of the two groups were compared.Multivariate logistic regression analysis was performed on cognitive impairment in patients.Results The scale scores of all 180 patients were at a low level,and there were 114 cases(63.33%)had cognitive dysfunction.In patients with cognitive dysfunction lacunar infarction,the language ability score in the basal ganglia group was significantly lower than that in the thalamus group,cortex or subcortical group and frontal lobe group(P<0.05).The delayed recall score in the frontal lobe group was significantly lower than that in the basal ganglia,thalamus group and cortex or subcortical group(P<0.05).The performance scores of basal ganglia and frontal lobe group were significantly higher than those of thalamus group and cortex or subcortical group(P<0.05).The total score of the basal ganglia group was significantly lower than that of the thalamus group,and the cortex or subcortical group(P<0.05).In patients with white matter lesions,the attention score of the LWI.group was significantly lower than that of the DWMIgroup,the FHl group and the OHl group(P<0.05).The delayed recall score of the FHl group was significantly lower than that of the DWML group,the OHL group and the LWL group(P<0.05).The performance score of the DWMIgroup was significantly lower than that of the FHL group,the OHIgroup and the LWIgroup(P<0.05).The executive ability score of the DWMI group was significantly lower than that of the FHI group,OHI group and the LWI group(P<0.05).The number of years of education was a protective factor to prevent cognitive impairment in patients(P<0.01).Old age,diabetes,and hyperlipidemia were independent risk factors for cognitive impairment in patients(P<0.05 or 0.01).Conclusion In patients with different types of CSVD,the characteristics of cognitive dysfunction in patients with different pathological changes are different,and advanced age,diabetes and hyperlipidemia are the risk factors of cognitive impairment in patients with CSVD.