老年脑小血管病影像学总负担评分与认知功能障碍的相关性分析

The correlation analysis of the total neuroimaging burden score and cognitive dysfunction in elderly patients with cerebral small vascular disease

目的研究老年人群脑小血管病(CSVD)的神经影像学特征总负担评分与认知障碍的关系。方法选取2016年6月-2019年5月于辽宁省金秋医院门诊就诊及住院的患者,年龄≥65岁,确诊CSVD的患者319名。采用脑小血管病总负担评分方法对无症状腔隙性梗死、脑白质病变、脑微出血及血管周围间隙扩大等4种CSVD神经影像学特征进行总体评估,记为0~4分。按分值分为轻度组(0分) 145例;中度组(1~2分) 131例和重度组(3~4分) 43例。应用简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估认知功能,并进行统计学分析。结果 CSVD重度组年龄与CSVD总负担评分呈正相关(r=0. 841,P=0. 035)。在MMSE评分中,重度组在记忆力子项分值低于轻度组;中、重度组在回忆能力子项分值低于轻度组(P=0. 029、0. 036)。在MoCA评分中,重度组在记忆力、语言能力子项分值低于轻度组(P=0. 031、0. 029);中、重度组在视空间与执行能力、延迟回忆子项分值低于轻度组(P=0. 036、0. 014)。结论 CSVD总负担评分是导致全脑损害的脑小血管病有效的影像学评估手段,CSVD总负担加重与整体认知下降相关,是认知功能障碍的预测因素。多种神经影像学特征合并存在的老年脑小血管病在记忆、延迟回忆、视空间执行能力、语言能力4个认知领域受损更重。

Objective To study the relationship between total neuroimaging burden score and cognitive dysfunction in elderly patients with cerebral small vascular disease( CSVD). Methods There was included 319 patients( aged ≥65 years) which were admitted to the outpatient or inpatient department of Jinqiu Hospital of Liaoning Province and wew diagnosed with CSVD,from June 2016 to May 2019. The total burden of CSVD was used to evaluate the four neuroimaging features that included asymptomatic lacunar infarction,white matter hyperintensity,cerebral microbleeds and enlarged perivascular space. The patients were divided into the mild group( 0 points) with 145 cases,the moderate group( 1 ~ 2 points)with 131 cases and the severe group( 3 ~ 4 points) with 43 cases. Mini-mental status inventory( MMSE) and Montreal cognitive assessment scale( MoCA) were used to assess the cognitive ability of the patients and the data of three groups were statistically analyzed. Results The total burden score was positively correlated with age of the severe group( r = 0. 841,P= 0. 035 < 0. 05). The memory score of severe group was lower than those of the mild group( P = 0. 029),and the recall ability score of moderate and severe groups were lower than those of the mild group( P = 0. 036) in the MMSE score. The memory and language ability score of the severe group was lower than those of the mild group( P = 0. 031,0. 029),and the visual space and executive ability and delayed recall score of moderate and severe groups were lower than those of the mild group( P = 0. 036,0. 014) in the MoCA score. Conclusion The total CSVD burden score is an effective imaging evaluation method for whole brain damage and associated with decreased overall cognitive function,may be a predictor of cognitive dysfunction. Combined and accumulating presence of the four neuroimaging features in CSVD were more serious performance to visual space and executive,memory,recall ability and language ability.