不同脑白质损伤部位对老年轻度认知障碍的影响

Influence of Different Location of White Matter Lesion on Mild Cognitive Impairment in Senile Patients

目的探讨不同部位脑白质损伤(white matter lesion,WML)对老年轻度认知障碍(mild cognitive impairment,MCI)的影响。方法选取200例经头颅MRI检查为WML且伴MCI的老年患者为WML组,选同期健康体检者40例作为对照组。根据病变部位将WML患者分为脑室旁组(n=64)、脑室下组(n=56)、皮层下组(n=46)和深部组(n=34)。采用蒙特利尔认知功能量表(Montreal cognitive assessment,MoCA)、简易智能量表(mini-mental state examination,MMSE)评价所有受试者的认知功能。结果WM L组和对照组的MMSE评分分别为23.04±1.42分和28.23±1.57分,MoCA总分分别为19.91±1.55分和25.94±2.32分,差异均有统计学意义(P分别为0.005和0.001)。在MoCA量表8个维度评分中,WML深部组的视空间/执行评分最低,皮层下组的命名及抽象思维评分最低,脑室旁组的计算和延迟回忆评分最低,脑室下组的注意力评分最低。皮层下组8个维度的分值均低于对照组,差异有统计学意义,认知领域受累范围最广泛。结论不同部位WML对老年患者认知功能及认知域的影响不同,皮层下组认知损害范围最广。

Objective To investigate the influence of different location of white matter lesion(WML) on mild cognitive impairment(MCI) in senile patients.Methods A total of 200 elderly patients with WML and MCI were enrolled in WML group, and 40 healthy physical examination adults were selected as control group. WML patients were divided into paraventricular subgroup(n =64), subventricular subgroup(n =56), subcortical subgroup(n=46) and deep subgroup(n=34) according to the lesion location. The cognitive function of all subjects were evaluated using the Montreal cognitive assessment(MoCA) and mini-mental state examination(MMSE).Results The MMSE scores of WML and control group were 23.04±1.42 and 28.23±1.57, respectively(P =0.005). The MoCA scores of WML and control group were 19.91±1.55 and 25.94±2.32, respectively(P =0.001). Among the 8 items of MoCA, the visual/executive scores of deep subgroup were the lowest, the naming and abstract thinking scores of subcortical group were the lowest, the calculation score and delayed recall score of paraventricular subgroup were the lowest, and the attention score of subventricular subgroup was the lowest. The scores of the 8 items in subcortical subgroup were all lower than that in control group, the differences were all statistically significant, and the involved cognitive domains were most extensive.Conclusions Different location of WML in the elderly patients had different influence on the cognitive domains, and the involved cognitive domains in patients with subcortical WML were most extensive.